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Recurrent sinus pauses: an atypical presentation of temporal lobe epilepsy.

Amor MM, Eltawansy SA, Osofsky J, Holland N - Case Rep Crit Care (2014)

Bottom Line: Autonomic dysfunction related to seizures may give rise to a broad spectrum of cardiovascular abnormalities.Failure to recognize these abnormalities may contribute to sudden, unexplained death in epilepsy patients.We report a case of a Haitian female with temporal lobe epilepsy associated with recurrent sinus pauses.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ 07740, USA.

ABSTRACT
Autonomic dysfunction related to seizures may give rise to a broad spectrum of cardiovascular abnormalities. Among these, ictal bradycardia and conduction delays may be encountered. Failure to recognize these abnormalities may contribute to sudden, unexplained death in epilepsy patients. We report a case of a Haitian female with temporal lobe epilepsy associated with recurrent sinus pauses.

No MeSH data available.


Related in: MedlinePlus

Telemetry tracing during the seizure episode, revealing sinus bradycardia, which eventually progressed to a 12-second pause.
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fig1: Telemetry tracing during the seizure episode, revealing sinus bradycardia, which eventually progressed to a 12-second pause.

Mentions: A 58-year-old Haitian female with known history of hypertension was admitted for severe bilateral lower extremity weakness. CT scan of the thoracolumbar spine revealed severe kyphosis of T10-T11 secondary to anterior collapse of the T11 vertebral body. She received intravenous steroids and was evaluated for surgical intervention. She eventually underwent T11 corpectomy, fusion of T10-T12, implantation of biomechanical device at T11, anterior instrumentation of T10-12, and posterolateral fusion of T8-L3. Bone biopsy revealed evidence of osteomyelitis. She was started on a 42-day course of antibiotics. After surgery, she was noted to be increasingly lethargic and confused. Rapid response was called when she developed a complex partial seizure with secondary generalization. The seizure was terminated upon administration of intravenous Ativan. She was given a 1500 mg loading dose of Keppra followed by 500 mg twice daily maintenance dose. EKG monitoring during the seizure episode revealed sinus bradycardia, which eventually progressed to a 10-second sinus pause, approximately 20 seconds after seizure onset (Figure 1). She had 2 more similar seizure episodes during the same day. In each seizure episode, she would develop sinus bradycardia, followed by sinus pauses a few seconds after seizure onset. Interictal EKGs revealed normal sinus rhythm. She was started on a dopamine infusion and transferred to the ICU. EEG revealed periodic lateralized epileptiform discharges and a single seizure emanating from the right posterior temporal region (Figure 2). The seizure observed during the EEG focally originated from the T6 area and then had secondary generalization. It lasted around 75 seconds and clinically manifested as blank staring. MRI revealed a large area of gyral edema, sulcal effacement, and cortically based diffusion restriction involving the right occipital lobe and right posterior temporal and parietal lobes (Figure 3). Lumbar tap revealed normal findings. She did not have any further seizure episodes. On the succeeding hospital day, she underwent DDD pacemaker insertion and did not develop any more pauses. Repeat EEG revealed no lateralizing or epileptiform discharges. Her prolonged hospital course was complicated by hemorrhagic pleural effusion, venous air embolism after central line removal, and surgical site infection. These complications were treated accordingly. She was discharged to an acute rehabilitation facility after 26 days of hospital stay.


Recurrent sinus pauses: an atypical presentation of temporal lobe epilepsy.

Amor MM, Eltawansy SA, Osofsky J, Holland N - Case Rep Crit Care (2014)

Telemetry tracing during the seizure episode, revealing sinus bradycardia, which eventually progressed to a 12-second pause.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4195260&req=5

fig1: Telemetry tracing during the seizure episode, revealing sinus bradycardia, which eventually progressed to a 12-second pause.
Mentions: A 58-year-old Haitian female with known history of hypertension was admitted for severe bilateral lower extremity weakness. CT scan of the thoracolumbar spine revealed severe kyphosis of T10-T11 secondary to anterior collapse of the T11 vertebral body. She received intravenous steroids and was evaluated for surgical intervention. She eventually underwent T11 corpectomy, fusion of T10-T12, implantation of biomechanical device at T11, anterior instrumentation of T10-12, and posterolateral fusion of T8-L3. Bone biopsy revealed evidence of osteomyelitis. She was started on a 42-day course of antibiotics. After surgery, she was noted to be increasingly lethargic and confused. Rapid response was called when she developed a complex partial seizure with secondary generalization. The seizure was terminated upon administration of intravenous Ativan. She was given a 1500 mg loading dose of Keppra followed by 500 mg twice daily maintenance dose. EKG monitoring during the seizure episode revealed sinus bradycardia, which eventually progressed to a 10-second sinus pause, approximately 20 seconds after seizure onset (Figure 1). She had 2 more similar seizure episodes during the same day. In each seizure episode, she would develop sinus bradycardia, followed by sinus pauses a few seconds after seizure onset. Interictal EKGs revealed normal sinus rhythm. She was started on a dopamine infusion and transferred to the ICU. EEG revealed periodic lateralized epileptiform discharges and a single seizure emanating from the right posterior temporal region (Figure 2). The seizure observed during the EEG focally originated from the T6 area and then had secondary generalization. It lasted around 75 seconds and clinically manifested as blank staring. MRI revealed a large area of gyral edema, sulcal effacement, and cortically based diffusion restriction involving the right occipital lobe and right posterior temporal and parietal lobes (Figure 3). Lumbar tap revealed normal findings. She did not have any further seizure episodes. On the succeeding hospital day, she underwent DDD pacemaker insertion and did not develop any more pauses. Repeat EEG revealed no lateralizing or epileptiform discharges. Her prolonged hospital course was complicated by hemorrhagic pleural effusion, venous air embolism after central line removal, and surgical site infection. These complications were treated accordingly. She was discharged to an acute rehabilitation facility after 26 days of hospital stay.

Bottom Line: Autonomic dysfunction related to seizures may give rise to a broad spectrum of cardiovascular abnormalities.Failure to recognize these abnormalities may contribute to sudden, unexplained death in epilepsy patients.We report a case of a Haitian female with temporal lobe epilepsy associated with recurrent sinus pauses.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Monmouth Medical Center, Long Branch, NJ 07740, USA.

ABSTRACT
Autonomic dysfunction related to seizures may give rise to a broad spectrum of cardiovascular abnormalities. Among these, ictal bradycardia and conduction delays may be encountered. Failure to recognize these abnormalities may contribute to sudden, unexplained death in epilepsy patients. We report a case of a Haitian female with temporal lobe epilepsy associated with recurrent sinus pauses.

No MeSH data available.


Related in: MedlinePlus