Diffuse Electrographic Suppression Associated with Increased Intracranial Pressure and Paroxysmal Neurologic Events in Patients with Leptomeningeal Carcinomatosis
Abstract number :
905
Submission category :
3. Neurophysiology / 3C. Other Clinical EEG
Year :
2020
Submission ID :
2423238
Source :
www.aesnet.org
Presentation date :
12/7/2020 1:26:24 PM
Published date :
Nov 21, 2020, 02:24 AM
Authors :
Erica Lewis, Geisinger Medical Center; Na Tosha Gatson - Geisinger Medical Center; Daniel Graf - Geisinger Medical Center; Cynthia Correll - Geisinger Medical Center;
Rationale:
Plateau waves of transient increased intracranial pressure (ICP) have been reported in the setting of paroxysmal neurological events and generalized slowing on electroencephalography (EEG) monitoring in patients with leptomeningeal carcinomatosis (LMC). These events are commonly misdiagnosed as seizures. Our study aims to better characterize these observed stereotyped events and their association with the distinctive EEG pattern of diffuse suppression.
Method:
We retrospectively reviewed clinical and video EEG data for two patients diagnosed with LMC.
Results:
Patient 1, a 52-year-old female presented with altered mentation, multiple cranial neuropathies and a one-month history of intermittent vertigo, headache, and blurred vision. Episodes of unresponsiveness were provoked by anger, crying, or straining. Contrasted brain MRI (MRI-C+) was consistent with radiographic LMC, the lumbar puncture (LP) opening pressure was >35 cmH2O, and cerebral spinal fluid cytology confirmed metastatic breast carcinoma. Stereotyped clinical events captured on video EEG included rightward head/eye deviation, behavioral arrest, tonic stiffening with arm extensor posturing, and agonal breathing. Events correlated with progressive EEG findings from normal to generalized rhythmic delta activity and diffuse suppression. Patient 2, a 58-year-old female presented with onset of episodic vertigo, altered mentation, and headaches two-months after resection of metastatic cerebellar breast carcinoma. MRI-C+ demonstrated extensive leptomeningeal enhancement and supratentorial hydrocephalus. During admission, the patient developed episodes of unresponsiveness and incontinence provoked by crying and psychological agitation. Placement of external ventricular drain, with opening pressure of 39 cmH2O, led to interval improvement of paroxysmal neurologic events. Video EEG captured stereotyped events of unresponsiveness, tonic posturing, incontinence, and agonal breaths correlated with abrupt electrographic suppression.
Conclusion:
Paroxysmal neurologic symptoms, misdiagnosed as seizures, correlate with diffuse suppression on video EEG and are associated with plateau waves of transient increased ICP. In the appropriate clinical context, this EEG signature may be a useful indicator of increased ICP in patients with LMC.
Funding:
:N/A
Neurophysiology