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Factitious psychogenic nonepileptic paroxysmal episodes.

Romano A, Alqahtani S, Griffith J, Koubeissi MZ - Epilepsy Behav Case Rep (2014)

Bottom Line: He then disconnected his EEG cables and had an episode of generalized stiffening and cyanosis, followed by jerking and profuse bleeding from the mouth.The manifestations were unusually similar to those of ES, except that he was clearly startled by spraying water on his face, while he was stiff in all extremities and unresponsive.There were indications that he had sucked blood from his central venous catheter to expel through his mouth during his PNEPEs while consciously holding his breath.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, George Washington University, Washington, DC, USA.

ABSTRACT
Mistaking psychogenic nonepileptic paroxysmal episodes (PNEPEs) for epileptic seizures (ES) is potentially dangerous, and certain features should alert physicians to a possible PNEPE diagnosis. Psychogenic nonepileptic paroxysmal episodes due to factitious seizures carry particularly high risks of morbidity or mortality from nonindicated emergency treatment and, often, high costs in wasted medical treatment expenditures. We report a case of a 28-year-old man with PNEPEs that were misdiagnosed as ES. The patient had been on four antiseizure medications (ASMs) with therapeutic serum levels and had had multiple intubations in the past for uncontrolled episodes. He had no episodes for two days of continuous video-EEG monitoring. He then disconnected his EEG cables and had an episode of generalized stiffening and cyanosis, followed by jerking and profuse bleeding from the mouth. The manifestations were unusually similar to those of ES, except that he was clearly startled by spraying water on his face, while he was stiff in all extremities and unresponsive. There were indications that he had sucked blood from his central venous catheter to expel through his mouth during his PNEPEs while consciously holding his breath. Normal video-EEG monitoring; the patient's volitional and deceptive acts to fabricate the appearance of illness, despite pain and personal endangerment; and the absence of reward other than remaining in a sick role were all consistent with a diagnosis of factitious disorder.

No MeSH data available.


Related in: MedlinePlus

Eleven-second sample of patient's normal EEG.
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f0005: Eleven-second sample of patient's normal EEG.

Mentions: Continuous video-EEG monitoring for 48 h captured no episodes and showed normal EEG (Fig. 1). An episode occurred after he disconnected his own EEG leads, which consisted of cyanosis and irregular, arrhythmic, intermittent stiffening and jerking of both legs with forceful flexion of the toes and left arm, while the right arm was extended and internally rotated with unusual twisted finger positioning. He did not respond to painful stimuli. With subsequent events, blood spewed profusely from his mouth. His eyes were forcefully closed, but his pupils were normal in size and reactive. However, the patient was clearly startled by spraying water on his face.


Factitious psychogenic nonepileptic paroxysmal episodes.

Romano A, Alqahtani S, Griffith J, Koubeissi MZ - Epilepsy Behav Case Rep (2014)

Eleven-second sample of patient's normal EEG.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4307878&req=5

f0005: Eleven-second sample of patient's normal EEG.
Mentions: Continuous video-EEG monitoring for 48 h captured no episodes and showed normal EEG (Fig. 1). An episode occurred after he disconnected his own EEG leads, which consisted of cyanosis and irregular, arrhythmic, intermittent stiffening and jerking of both legs with forceful flexion of the toes and left arm, while the right arm was extended and internally rotated with unusual twisted finger positioning. He did not respond to painful stimuli. With subsequent events, blood spewed profusely from his mouth. His eyes were forcefully closed, but his pupils were normal in size and reactive. However, the patient was clearly startled by spraying water on his face.

Bottom Line: He then disconnected his EEG cables and had an episode of generalized stiffening and cyanosis, followed by jerking and profuse bleeding from the mouth.The manifestations were unusually similar to those of ES, except that he was clearly startled by spraying water on his face, while he was stiff in all extremities and unresponsive.There were indications that he had sucked blood from his central venous catheter to expel through his mouth during his PNEPEs while consciously holding his breath.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, George Washington University, Washington, DC, USA.

ABSTRACT
Mistaking psychogenic nonepileptic paroxysmal episodes (PNEPEs) for epileptic seizures (ES) is potentially dangerous, and certain features should alert physicians to a possible PNEPE diagnosis. Psychogenic nonepileptic paroxysmal episodes due to factitious seizures carry particularly high risks of morbidity or mortality from nonindicated emergency treatment and, often, high costs in wasted medical treatment expenditures. We report a case of a 28-year-old man with PNEPEs that were misdiagnosed as ES. The patient had been on four antiseizure medications (ASMs) with therapeutic serum levels and had had multiple intubations in the past for uncontrolled episodes. He had no episodes for two days of continuous video-EEG monitoring. He then disconnected his EEG cables and had an episode of generalized stiffening and cyanosis, followed by jerking and profuse bleeding from the mouth. The manifestations were unusually similar to those of ES, except that he was clearly startled by spraying water on his face, while he was stiff in all extremities and unresponsive. There were indications that he had sucked blood from his central venous catheter to expel through his mouth during his PNEPEs while consciously holding his breath. Normal video-EEG monitoring; the patient's volitional and deceptive acts to fabricate the appearance of illness, despite pain and personal endangerment; and the absence of reward other than remaining in a sick role were all consistent with a diagnosis of factitious disorder.

No MeSH data available.


Related in: MedlinePlus