RESUMEN
Tramadol has been reported to cause seizures in therapeutic dosing and in overdose. We present a series of 2 infants poisoned with tramadol, both presenting with abnormal neurologic findings: either seizures or seizurelike activity. Tramadol poisoning should be considered in the differential diagnosis of dystonia and seizures.
Asunto(s)
Analgésicos Opioides/envenenamiento , Epilepsia/inducido químicamente , Tramadol/envenenamiento , Diagnóstico Diferencial , Distonía/diagnóstico , Epilepsia/sangre , Epilepsia/diagnóstico , Femenino , Cromatografía de Gases y Espectrometría de Masas , Humanos , Lactante , MasculinoRESUMEN
Apnea as an isolated manifestation of seizures is well described in neonates but is only occasionally observed in infants. This article reports 3 infants presenting with apneic events as the main manifestation of seizure, documented by video electroencephalogram, all with mesial temporal lobe lesions. The 3 infants, after normal pregnancy and delivery at term, showed the first apnea at the age of 4 to 10 months. Although the interictal electroencephalogram result was often normal, ictal video electroencephalogram in all infants showed focal rhythmic discharges with or without generalization. Magnetic resonance imaging showed an inferior mesial temporal lobe mass lesion in all infants. All patients underwent lesion removal, and they are seizure free with normal psychomotor development.
Asunto(s)
Apnea/etiología , Astrocitoma/complicaciones , Neoplasias Encefálicas/complicaciones , Epilepsia del Lóbulo Temporal/etiología , Epilepsia/etiología , Ganglioglioma/complicaciones , Lóbulo Temporal/patología , Apnea/fisiopatología , Astrocitoma/patología , Neoplasias Encefálicas/patología , Electroencefalografía , Epilepsia/diagnóstico , Epilepsia/fisiopatología , Epilepsia del Lóbulo Temporal/diagnóstico , Epilepsia del Lóbulo Temporal/fisiopatología , Femenino , Ganglioglioma/patología , Humanos , Lactante , Imagen por Resonancia Magnética , Masculino , Procedimientos Neuroquirúrgicos , Lóbulo Temporal/fisiopatología , Resultado del TratamientoRESUMEN
The issue of whether seizures can arise in the cerebellum remains controversial. The authors present the first known case of focal subcortical epilepsy with secondary generalization thought to arise from a dysplastic lesion within the cerebellum. A newborn infant presented with daily episodes of left eye blinking, stereotyped extremity movements, postural arching, and intermittent altered consciousness lasting less than 1 minute. These episodes began on his 1st day of life and progressively increased in frequency to more than 100 events per day. Antiepileptic medications had no effect, and interictal and ictal scalp electroencephalography (EEG) recordings demonstrated bilateral electrical abnormalities. Magnetic resonance imaging revealed a mass in the left cerebellar hemisphere, and ictal and interictal single-photon emission computerized tomography revealed a focal perfusion abnormality in the region of the cerebellar mass. The patient subsequently underwent intraoperative EEG monitoring with cortical scalp electrodes and cerebellar depth electrodes. Intraoperative EEG recordings revealed focal seizure discharges that arose in the region of the cerebellar mass and influenced electrographic activity in both cerebral hemispheres. Resection of this mass and the left cerebellar hemisphere led to complete resolution of the patient's seizures and normalization of the scalp EEG readings. Neuropathological findings in this mass were consistent with ganglioglioma. A review of the literature on the cerebellar origins of epilepsy is included.
Asunto(s)
Neoplasias Cerebelosas/patología , Epilepsias Parciales/patología , Epilepsia Generalizada/patología , Ganglioglioma/patología , Corteza Cerebelosa/patología , Corteza Cerebelosa/fisiopatología , Neoplasias Cerebelosas/complicaciones , Epilepsias Parciales/etiología , Epilepsias Parciales/fisiopatología , Epilepsia Generalizada/etiología , Epilepsia Generalizada/fisiopatología , Ganglioglioma/complicaciones , Humanos , Recién Nacido , Masculino , Neuronas Motoras/patologíaRESUMEN
The purpose of this study is to describe two infants that were diagnosed with Walker-Warburg syndrome (WWS), a rare form of congenital muscular dystrophy (CMD). They were studied in their clinical, laboratory, and neuroradiologic features. The index case had a brain magnetic resonance imaging (MRI) and the second patient had a head computerized tomography (CT). In addition, a literature review was performed to describe the main forms of CMD. The index case fulfilled all criteria for WWS. A brain MRI performed at age 4 months served to corroborate the clinical diagnosis, showing severe hydrocephalus, type II lissencephaly, cerebellar vermian aplasia, and a hypoplastic brain stem. The authors were able to establish a retrospective diagnosis of WWS in the index cases's older sister, based upon her clinical picture and head CT report.