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Encephalopathy mimicking non-convulsive status Epilepticus

Ramachandiran Nandhagopal, Fathiya Al-Murshedi, Mujahid Al-Busaidi and Amna Al-Busaidi
Neurosciences Journal January 2018, 23 (1) 52-56; DOI: https://doi.org/10.17712/nsj.2018.1.20170214

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Figures

  • Figure 1
    Figure 1

    Timeline picture of the clinical course of Patient #1(a 30-year-old woman) with hyperammonemic encephalopathy mimicking non-convulsive status epilepticus

  • Figure 2
    Figure 2

    EEG obtained during an unresponsive episode (A) in a 30-year-old woman (Patient# 1) showed continuous, frontally dominant, generalized, 2.5 Hz sharp and wave discharges, with a triphasic morphology in some channels (e.g., Fz-Cz). Following intravenous administration of diazepam (B), there was complete resolution of this pattern, with the appearance of diffuse slowing in the theta range and movement artefacts (patient opened her eyes and withdrew her limbs to painful stimuli and then sat up in the bed and attempted to remove the electrodes) indicating arousal. (Low-frequency filter 0.3 Hz, high-frequency filter 50 Hz).

  • Figure 3
    Figure 3

    Marked worsening of hyperammonemia in relation to carbohydrate infusion that was provided as part of the standard treatment protocol for episodic hyperammonemic encephalopathy (mimicking non-convulsive status epilepticus) in a previously undiagnosed case (patient#1) of adult-onset citrullinemia. The plasma glucose and lactate values are in mmol/l.

  • Figure 4
    Figure 4

    Timeline picture of the clinical course of Patient #2 (a 19-year-old man) with hyperammonemic encephalopathy mimicking non-convulsive status epilepticus

  • Figure 5
    Figure 5

    EEG obtained during an episode of hyperammonemic encephalopathy (A) with a plasma ammonia level of 105 µmol/l in a 19-year-old man (patient# 2) with a known diagnosis of arginase deficiency showed continuous, frontally dominant, generalized, 2.5 Hz sharp and wave discharges, similar to Figure 1A. Twenty hours following the standard treatment protocol for hyperammonemia that included infusion of dextrose and ammonia scavenger (B), he was conscious and alert and the corresponding EEG normalized to a posterior dominant alpha background rhythm without any ictal discharges. (Low-frequency filter 1 Hz, high-frequency filter 70 Hz).

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