Rapidly Progressive Cognitive Disturbances Due to Nonconvulsive Status Epilepticus Associated with a Cerebral Microbleed: Clinical Application of FDG-PET

DOI IR (HANDLE) HANDLE 14 References Open Access
  • Nakagami Yukako
    Department of Psychiatry, Kyoto University Graduate School of Medicine, Shogoin-Kawaharacho 54, Kyoto, 606-8507, Japan
  • Sugihara Genichi
    Department of Psychiatry, Kyoto University Graduate School of Medicine, Shogoin-Kawaharacho 54, Kyoto, 606-8507, Japan
  • Uemura Kengo
    Department of Neurology, Kyoto University Graduate School of Medicine, Shogoin-Kawaharacho 54, Kyoto, 606-8507, Japan
  • Jingami Naoto
    Department of Neurology, Kyoto University Graduate School of Medicine, Shogoin-Kawaharacho 54, Kyoto, 606-8507, Japan
  • Ueda Keita
    Department of Psychiatry, Kyoto University Graduate School of Medicine, Shogoin-Kawaharacho 54, Kyoto, 606-8507, Japan
  • Takahashi Ryosuke
    Department of Neurology, Kyoto University Graduate School of Medicine, Shogoin-Kawaharacho 54, Kyoto, 606-8507, Japan
  • Murai Toshiya
    Department of Psychiatry, Kyoto University Graduate School of Medicine, Shogoin-Kawaharacho 54, Kyoto, 606-8507, Japan
  • 杉原, 玄一
  • 60866185
  • 70402261
  • 80808460
  • 60573079
  • 90216771
  • 30335286

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Description

Cerebral microbleeds (CMBs) usually produce no symptoms. We encountered a patient who developed cognitive decline and psychotic symptoms associated with nonconvulsive status epilepticus (NCSE), with presumptive epileptogenic focus possibly caused by a CMB. A 70-year-old man developed progressive cognitive disturbances including disorientation and hallucinations two months after a mild head injury. He was admitted to our hospital three months after the trauma, because of progression of symptoms. The first positron emission tomography (PET) with [18F]fluoro-2-deoxy-d-glucose (FDG) demonstrated intense FDG uptake in the left occipitoparietal region, in which a CMB was detected by T2∗-weighted magnetic resonance imaging (MRI). Electroencephalography showed continuous slow waves in the left occipital and parietal areas. After anticonvulsive therapy, his symptoms completely disappeared, accompanied by change in FDG uptake. Our case suggests that CMBs may be an epileptogenic focus of NCSE, and that FDG-PET is useful for the diagnosis of NCSE and assessment of therapeutic efficacy.

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