Clinical Reasoning: A 56-Year-Old Man With Unusual Presentation of Subacute Encephalopathy and Seizure. (4th January 2022)

• Record Type: Journal Article
• Authors: Wang, Tian; Safadi, Amy Li; Lee, Earn Chun Christabel; Bicher, Nathan; Barry, Brian; Sirdar, Bilaal; Motamedi, Gholam K.; Osborne, Benjamin
• Is Part Of: Neurology. Volume 98:Number 1(2022)
• Page Start: e95
• Page End: e102
• Publication Date: 2022-01-04
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000012951
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : A 56-year-old, right-handed man presented with subacute confusion and seizures following a recent stroke. The ischemic event occurred in the left medial temporal region, resulting in right-sided hemiparesis, dysphagia, and dysarthria. The patient's family noticed cognitive decline after the stroke, including difficulties with reading, spelling, and recognizing faces. The stroke workup revealed elevated low-density lipoproteins (200) and hemoglobin A1c (6.5), as well as a normal echocardiogram. A treatment of aspirin and atorvastatin was started. The first seizure, which occurred 1 month after the stroke, also prompted the use of levetiracetam (500 mg) twice a day. This treatment proved effective until the day of admission, when the patient presented with multiple episodes of focal motor to bilateral tonic-clonic seizure, persisting more than 5 minutes, and convulsive status epilepticus. He received lorazepam, which successfully resolved the episodes.