Three Cases of Aphasic Status Epilepticus: Clinical and Electrographic Characteristics

Aphasic status epilepticus (ASE) is unusual and has clinical characteristics similar to those of other disorders. Herein, we report 3 cases of ASE. A left-handed man (patient 1) showed continuous aphasia after the administration of flumazenil. He had underlying alcoholic liver cirrhosis and traumatic brain lesions in the right hemisphere. Electroencephalography (EEG) revealed periodic epileptiform discharges in the right frontotemporal area, which were intervened by rhythmic activity with spatiotemporal evolutions. A right-handed woman (patient 2) showed recurrent aphasia. Blood tests revealed a high blood glucose level (546 mg/dL) and high serum osmolality (309 mMol/L). Her EEG showed rhythmic activity in the left frontotemporal area with spatiotemporal evolutions on a normal background rhythm. She became seizure-free after the administration of an antiepileptic drug and strict glucose regulation. A right-handed woman (patient 3) developed subacute aphasia a week before hospital admission. She had a gradual decline of cognition 1 year before. Her EEG showed intermittent quasi-rhythmic fast activity in the frontotemporal area bilaterally, with fluctuating frequency and amplitude. The patient became seizure-free after the administration of an antiepileptic drug. Brain single-photon emission tomography performed after seizure control showed decreased perfusion in the left frontotemporal area. After discharge, her cognitive function gradually declined to a severe state of dementia. ASE can be caused by diverse etiologies; it is usually caused by cerebral lesions and less frequently by non-lesional etiologies or degenerative disorders. Adequate treatment of underlying disorders and seizures is critical for curing the symptoms of ASE.

Event-Related Potential Evidence of Enhanced Visual Processing in Auditory-Associated Cortex in Adults with Hearing Loss

Objective: The present study investigated the characteristics of visual processing in the auditory-associated cortex in adults with hearing loss using event-related potentials. Methods: Ten subjects with bilateral postlingual hearing loss were recruited. Ten age- and sex-matched normal-hearing subjects were included as controls. Visual (“sound” and “non-sound” photos)-evoked potentials were performed. The P170 response in the occipital area as well as N1 and N2 responses in FC3 and FC4 were analyzed. Results: Adults with hearing loss had higher P170 amplitudes, significantly higher N2 amplitudes, and shorter N2 latency in response to “sound” and “non-sound” photo stimuli at both FC3 and FC4, with the exception of the N2 amplitude which responded to “sound” photo stimuli at FC3. Further topographic mapping analysis revealed that patients had a large difference in response to “sound” and “non-sound” photos in the right frontotemporal area, starting from approximately 200 to 400 ms. Localization of source showed the difference to be located in the middle frontal gyrus region (BA10) at around 266 ms. Conclusions: The significantly stronger responses to visual stimuli indicate enhanced visual processing in the auditory-associated cortex in adults with hearing loss, which may be attributed to cortical visual reorganization involving the right frontotemporal cortex.

Structural and functional analyses of the occipital cortex in visual impaired patients with visual loss before 14 years old

Single photon emission tomography (SPECT) perfusion images of the brain of individuals with complete visual loss before the age of 14 were carried out and compared to those of visually normal subjects, in order to assess hypothetical differences in brain structural and metabolism between the two groups. Study group was comprised by 2 females and 3 males, aged 30 ± 10 years. Controls were composed by 6 females and 5 males aged 41.5 ± 3.8 years. All individuals were submitted to physical and neurological examinations, and to MRI and to SPECT. Blind subjects presented larger perfusion measurements bilaterally in their medial temporal lobes (p=0.030, right side; p=0.01, left side), but smaller perfusion measurements in their left frontotemporal area than controls (p=0.026). Intragroup analysis of the study group disclosed asymmetric perfusion, lesser in the left temporal and parietal areas (p=0.026 and p<0.0001, respectively) compared to the right side. In the healthy controls, reduced perfusion was also noted at the left parietal areas when compared to the right side (p=0.035). The study revealed that completely blind patients that became visually impaired before the age of 14 in spite of not having MRI detectable changes in their brain's anatomy do present increases in perfusion of their left and right medial temporal lobes, and a reduction in the perfusion of the left frontotemporal area, as compared to normal controls. While the increases in blood flow may reflect compensatory mechanisms for visual deprivation, the significance of the diminished perfusion in the left frontotemporal area remains elusive.

Giant intracranial and extracranial cavernous malformation

✓ Massive enlargement of an extracerebral cavernous malformation and extension across tissue planes is very uncommon. The authors present the case of a 49-year-old woman with a giant cavernous malformation in the left frontotemporal area. It progressively enlarged during several decades, extended through the calvaria to the extradural space, and was surgically treated. The lesion may have originated in the soft tissue or the skull. The locations of cavernous malformations in various parts of the body are reviewed and their mechanisms of growth are discussed. Surgical excision is the treatment of choice.