PMID- 29951957
OWN - NLM
STAT- MEDLINE
DCOM- 20200110
LR  - 20220126
IS  - 1556-0961 (Electronic)
IS  - 1541-6933 (Linking)
VI  - 30
IP  - 3
DP  - 2019 Jun
TI  - Loss of Vestibular Ocular Reflex in Nonconvulsive Status Epilepticus.
PG  - 675-680
LID - 10.1007/s12028-018-0567-z [doi]
AB  - BACKGROUND: Electroencephalogram (EEG) findings of generalized periodic 
      discharges (GPDs) with triphasic morphology were introduced as a metabolic 
      phenomenon, but more recently have been associated with epileptic phenomenon. 
      Resolution of EEG findings along with clinical improvement from treatment is 
      diagnostic. The known causes of reversible, isolated loss of OVR include 
      medication toxicity, lead exposure, and thiamine deficiency, but its association 
      with nonconvulsive status epilepticus (NCSE) has never been published. Medication 
      induced loss of OVR resolves after a 24-hour washout period. We report a case of 
      reversible, isolated loss of vestibular ocular reflex (VOR) associated with 
      epileptic phenomenon. METHODS: This is a case report of a single patient. 
      RESULTS: A 74-year-old male with a history of complex partial seizures admitted 
      for a pneumonectomy had a post-operative course complicated by two instances of 
      coma, the latter associated with an isolated loss of VOR. EEG revealed GPDs with 
      triphasic morphology initially interpreted as a metabolic phenomenon. The 
      patient's mental status, exam and EEG findings improved after low dose infusion 
      of propofol for tracheostomy, and he was eventually discharged at baseline 
      neurological function. Due to this response, his coma, loss of VOR and EEG were 
      later interpreted as a consequence of NCSE. CONCLUSION: The interpretation of 
      GPDs with triphasic wave morphology range from metabolic phenomenon to NCSE. NCSE 
      should be highly considered on the differential for encephalopathy regardless of 
      the circumstances. NCSE may be a potential cause of reversible, isolated loss of 
      the VOR and an AED trial in the appropriate clinical context should be 
      considered. This is the first report of loss of VOR possibly associated with 
      NCSE.
FAU - Kang, Jennifer H
AU  - Kang JH
AD  - Department of Neurology, Duke University Medical Center, DUMC 2905, Durham, NC, 
      27710, USA. Jennifer.kang@duke.edu.
FAU - Husain, Aatif M
AU  - Husain AM
AD  - Department of Neurology, Duke University Medical Center, DUMC 2905, Durham, NC, 
      27710, USA.
AD  - Neurodiagnostic Center, Veterans Affairs Medical Center, Durham, NC, USA.
AD  - Neuroscience Medicine, Duke Clinical Research Institute, Durham, NC, USA.
FAU - Morgenlander, Joel C
AU  - Morgenlander JC
AD  - Department of Neurology, Duke University Medical Center, DUMC 2905, Durham, NC, 
      27710, USA.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Neurocrit Care
JT  - Neurocritical care
JID - 101156086
SB  - IM
MH  - Aged
MH  - Electroencephalography
MH  - Humans
MH  - Male
MH  - Reflex, Vestibulo-Ocular/*physiology
MH  - Status Epilepticus/*diagnosis/*physiopathology
EDAT- 2018/06/29 06:00
MHDA- 2020/01/11 06:00
CRDT- 2018/06/29 06:00
PHST- 2018/06/29 06:00 [pubmed]
PHST- 2020/01/11 06:00 [medline]
PHST- 2018/06/29 06:00 [entrez]
AID - 10.1007/s12028-018-0567-z [pii]
AID - 10.1007/s12028-018-0567-z [doi]
PST - ppublish
SO  - Neurocrit Care. 2019 Jun;30(3):675-680. doi: 10.1007/s12028-018-0567-z.