Ictal paralysis with tonic eye gazing mimicking a pontine infarction

Concomitant positive and negative motor phenomena in a single seizure have not been reported before. We used an extensive history review, neurological examination, EEG, MRI and SPECT study to demonstrate a rare combination of motor presentations as an ictal phenomenon. A 64-year-old male was brought...

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Bibliographic Details
Published in:Seizure (London, England) England), 2006-12, Vol.15 (8), p.637-642
Main Authors: Tseng, Yu-Lung, Chen, Ying-Fa, Lai, Shung-Lon
Format: Article
Language:English
Subjects:
Amygdala - pathology
Brain Stem Infarctions - diagnosis
Diagnosis, Differential
Electroencephalography
Epilepsy - complications
Epilepsy - diagnosis
Eye Movements - physiology
Focal akinetic seizure
Humans
Ictal paralysis
Magnetic Resonance Imaging
Male
Middle Aged
MRI
Paresis - etiology
Pons
Pontine infarction
Seizures - diagnosis
SPECT
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Summary:Concomitant positive and negative motor phenomena in a single seizure have not been reported before. We used an extensive history review, neurological examination, EEG, MRI and SPECT study to demonstrate a rare combination of motor presentations as an ictal phenomenon. A 64-year-old male was brought to the emergency room with dizziness, progressive drowsiness and left hemiparesis. A spontaneous eye deviation to the left side with nystagmus was observed. A right pontine lesion was tentatively diagnosed. However, a focal motor seizure of the patient's left face and limbs occurred 3.5 h later. A brain MRI revealed a high signal in the right amygdala, hippocampus and thalamus, instead of the pons. An EEG showed periodic epileptic discharges in the right posterior temporal parietal region. Regional hyperperfusion was found by brain SPECT. The level of consciousness improved dramatically after adequate phenytoin treatment. A posterior temporal–parietal seizure can present with a prolonged ictal paralysis, a positive ocular nystagmoid deviation and an altered level of consciousness. The EEG is essential for a correct diagnosis, especially with a negative or an unexplainable MRI study. The SPECT has an additional role for the differential diagnosis.
ISSN:1059-1311
1532-2688
DOI:10.1016/j.seizure.2006.08.003