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A Case of Hyperventilation Syndrome Mimicking Complex Partial Seizure: Usefulness of EEG Monitoring in Emergency Department.

Kang BS - J Epilepsy Res (2015)

Bottom Line: In contrast, it is not clear whether hyperventilation can activate the partial seizures.We reported a case of acute hyperventilation syndrome (HSV) mimicking first onset complex partial seizure, impending non-convulsive status epilepticus, which was diagnosed by EEG in the emergency department.The electrographic seizure was provoked again by voluntary hyperventilation after clinical improvement.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Korea University Anam Hospital, Seoul, Korea.

ABSTRACT
Acute hyperventilation syndrome not only can be clinically misdiagnosed as epileptic seizures, but also complex partial seizures may involve hyperventilation as a part of aura. Although electrography (EEG) monitoring is one of the most important procedure to differentiate these conditions, it could not be widely used in emergency department. Variety forms of epileptic attack, mainly idiopathic generalized epilepsy, are provoked by voluntary hyperventilation. In contrast, it is not clear whether hyperventilation can activate the partial seizures. We reported a case of acute hyperventilation syndrome (HSV) mimicking first onset complex partial seizure, impending non-convulsive status epilepticus, which was diagnosed by EEG in the emergency department. The electrographic seizure was provoked again by voluntary hyperventilation after clinical improvement.

No MeSH data available.


Related in: MedlinePlus

Brain CT. (A) reveals no abnormality and MRI (B) shows no remarkable abnormality, except white matter changes.
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f1-er-5-1-20: Brain CT. (A) reveals no abnormality and MRI (B) shows no remarkable abnormality, except white matter changes.

Mentions: The arterial blood gas analysis showed respiratory alkalosis (pH 7.431, pCO2 28.0 mmHg, pO2 100.6 mmHg, HCO3 18.8 mmol/L, O2 saturation 98.1%). There were no abnormalities on complete blood counts, chemistry panel, urinalysis and electrocardiography. There was no obvious evidence of brain injury in CT (Fig. 1A). Since her consciousness was not recovered until 2 hours after visiting, she underwent continuous EEG monitoring at emergency department. EEG revealed recurrent rhythmic theta waves in the right temporal areas with secondary bilateral synchrony (Fig. 2A, B). Brain MRI including diffusion weighted image showed no remarkable lesion except multiple dots in white mater (Fig. 1B). With intravenous lorazepam (4 mg) followed by intravenous levetiracetam (2,000 mg) treatment, she recovered without any complication 1 day after admission. Follow-up EEG reveals normal background activities (Fig. 2C) but electrographic seizure was provoked at 30 seconds after hyperventilation ended (Fig. 2D).


A Case of Hyperventilation Syndrome Mimicking Complex Partial Seizure: Usefulness of EEG Monitoring in Emergency Department.

Kang BS - J Epilepsy Res (2015)

Brain CT. (A) reveals no abnormality and MRI (B) shows no remarkable abnormality, except white matter changes.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4494991&req=5

f1-er-5-1-20: Brain CT. (A) reveals no abnormality and MRI (B) shows no remarkable abnormality, except white matter changes.
Mentions: The arterial blood gas analysis showed respiratory alkalosis (pH 7.431, pCO2 28.0 mmHg, pO2 100.6 mmHg, HCO3 18.8 mmol/L, O2 saturation 98.1%). There were no abnormalities on complete blood counts, chemistry panel, urinalysis and electrocardiography. There was no obvious evidence of brain injury in CT (Fig. 1A). Since her consciousness was not recovered until 2 hours after visiting, she underwent continuous EEG monitoring at emergency department. EEG revealed recurrent rhythmic theta waves in the right temporal areas with secondary bilateral synchrony (Fig. 2A, B). Brain MRI including diffusion weighted image showed no remarkable lesion except multiple dots in white mater (Fig. 1B). With intravenous lorazepam (4 mg) followed by intravenous levetiracetam (2,000 mg) treatment, she recovered without any complication 1 day after admission. Follow-up EEG reveals normal background activities (Fig. 2C) but electrographic seizure was provoked at 30 seconds after hyperventilation ended (Fig. 2D).

Bottom Line: In contrast, it is not clear whether hyperventilation can activate the partial seizures.We reported a case of acute hyperventilation syndrome (HSV) mimicking first onset complex partial seizure, impending non-convulsive status epilepticus, which was diagnosed by EEG in the emergency department.The electrographic seizure was provoked again by voluntary hyperventilation after clinical improvement.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Korea University Anam Hospital, Seoul, Korea.

ABSTRACT
Acute hyperventilation syndrome not only can be clinically misdiagnosed as epileptic seizures, but also complex partial seizures may involve hyperventilation as a part of aura. Although electrography (EEG) monitoring is one of the most important procedure to differentiate these conditions, it could not be widely used in emergency department. Variety forms of epileptic attack, mainly idiopathic generalized epilepsy, are provoked by voluntary hyperventilation. In contrast, it is not clear whether hyperventilation can activate the partial seizures. We reported a case of acute hyperventilation syndrome (HSV) mimicking first onset complex partial seizure, impending non-convulsive status epilepticus, which was diagnosed by EEG in the emergency department. The electrographic seizure was provoked again by voluntary hyperventilation after clinical improvement.

No MeSH data available.


Related in: MedlinePlus