Neurosyphilis Presenting As Status Epilepticus, Successively Hemiparesis And Aphasia

Background: Neurosyphilis can occur anytime and present with a myriad of symptoms. Lissauer form of General Paresis Insane (GPI) is rare. We can learn more about this form of GPI through this case report.Case Presentation: The patient presented as status epilepticus, successively as hemiparesis and aphasia, which may be considered as the Todd's paresis or stroke. By performing the reactive serum rapid plasma reagent test and cerebrospinal fluid analysis, as well as the brain MRI results, we made the diagnosis as Lissauer form of GPI. The patient was started on intravenous penicillin for a total of 14 days. After that, the patient appeared with marked clinical improvement. Cognitive ability was better than before. Conclusions: GPI typically has a progressive course and normally presents 10 to 30 years after the initial infection. The manifestations of this patient and his suspicious history of Transient Ischemic Attacks (TIA) may mislead to the diagnosis of Todd's paresis or stroke. The prevalence of syphilis is rising again in recent years. To date, there is no gold standard for the diagnosis of neurosyphilis. Early diagnosis is of great importance as effective penicillin therapy is available.

Todd’s paresis following vasovagal syncope provoked by tilt-table testing

A 38-year-old woman presented with a history of recurrent episodes of transient loss of consciousness (TLOC) with seizure-like activity and post-TLOC left sided paresis. Electroencephalogram and MRI of the brain were normal, and events were not controlled by anti-convulsant therapy. Tilt testing produced reflex mixed pattern vasovagal syncope, with exact symptom reproduction, including bilateral upper and lower limb myoclonic movements and post-TLOC left hemiparesis that persisted for 27 min. A witness for the tilt event confirmed reproduction of patients ‘typical’ TLOC event. Syncope is the most frequent cause of TLOC. Myoclonic movements during syncope are not uncommon and can be misdiagnosed as epilepsy. It is rare to experience paresis after syncope, which in this case, lead to misdiagnosis and unnecessary anti-convulsant treatment.

Prognosis in Children With Febrile Seizures

Febrile seizures occurred in 3.5% of white and 4.2% of black children who were followed up in a large prospectively defined cohort. The frequency of adverse outcomes was examined in this population and risk factors were identified. Among 1,706 children with febrile seizures, no deaths or persistent motor deficits occurred as sequelae of seizures. Todd's paresis occurred in 0.4%. Risk factors identified for epilepsy after febrile seizures were family history of afebrile seizures, preexisting neurological abnormality, and complicated initial seizure. Of the 60% of children with febrile seizures who had none of these factors, 1% developed epilepsy by age 7 years. A single risk factor was present in 34%, of whom 2% developed epilepsy. Of the 6% with two or more of these factors, 10% developed epilepsy. After an initial brief febrile seizure, 1.4% experienced a subsequent attack which lasted 30 minutes or longer; none of these children had an afebrile seizure by the age of 7 years. Febrile seizures were associated with an increased risk of intellectual deficit only among children with preexisting neurological or developmental abnormality, and in those who developed subsequent afebrile seizures. A third of the children with febrile seizures had a recurrence, and 9% had three or more recurrences. The major predictor of recurrence was early age at onset.