愛麗絲症侯群和矢狀竇血栓

20240108
早上看到一個很特別的case report

每次看這種文章都覺得^^像在看<House>

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前陣子朋友跟我提到長輩出現奇特的語言行為, 

如果是你, 你會怎麼想呢? 歸於鬼神?

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這個case是個23歲男性, 右眼框痛, 和視覺錯覺, 

1.經實驗室檢查、腦部CT檢查、靜脈造影、眼科檢查和神經評估,除了視覺空間困難和建構性失調外,均正常。

2.進行了腦電圖檢查,顯示右側顳枕葉非痙攣性狀態發作

3.而對比後的T1顯示出優勢矢狀竇血栓

(好敏銳的醫師啊, 嘆, 醫生緣真好, 這位患者)

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好了, 晨間報紙時間已過, 要去工作了

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原文中:

標題:COVID-19患者罕見的非痙攣性狀態發作:愛麗絲仙境綜合症"透過鏡子"在腦靜脈竇血栓和COVID-19罕見表現中的案例報告


第一段:介紹

愛麗絲仙境綜合症(AIWS)是一種罕見的知覺障礙,很少與癲癇有關。我們報告了一名23歲男性的病例,他突然出現右眼眶頭痛和視覺錯覺,與AIWS Type B一致,經實驗室檢查、腦部CT檢查、靜脈造影、眼科檢查和神經評估,除了視覺空間困難和建構性失調外,均正常。根據篩查協議進行的鼻咽SARS-CoV2拭子檢查呈陽性。由於AIWS持續存在,進行了腦電圖檢查,顯示右側顳枕葉非痙攣性狀態發作;使用抗癲癇藥物進行緩慢解決臨床和腦電圖改變。腦部MRI顯示右側皮質顳枕區信號異常,與期間性改變一致,而對比後的T1顯示出優勢矢狀竇血栓,因此啟動了抗凝治療。AIWS與顳頂枕交叉區的異常相關,該區整合視覺和體感輸入以生成身體模式的表示。在這名患者中,AIWS是由顳枕部位的非痙攣性狀態引起的,無解剖和腦電圖參與頭頂區域的情況,與該綜合症的缺乏體感症狀一致。狀態發作可能是腦靜脈竇血栓(CVST)的首發症狀,在這種情況下,可能是與COVID-19相關的高凝狀態所致。


第二段:愛麗絲仙境綜合症的特徵

AIWS是一種罕見的知覺障礙,通常表現為視覺錯覺,患者可能感到物體變大或變小,時間感可能扭曲,並且對視覺刺激的感知可能受到影響。雖然這種症狀很少與癲癇有關,但在這名患者中,AIWS的出現是由於非痙攣性狀態發作引起的,這是一種不尋常的情況。


第三段:疾病的診斷和治療

這名患者接受了多種檢查,包括實驗室檢查、影像學檢查和神經評估,以確定病因。診斷後,他接受了抗癲癇藥物治療和抗凝治療,以緩解症狀並處理腦靜脈竇血栓。這突顯了確定根本原因的重要性,以制定適當的治療計劃。


第四段:結論

這個案例突顯了COVID-19可能引起的罕見且不尋常的症狀,並強調了確診和治療的重要性。愛麗絲仙境綜合症的非典型表現需要醫療專業人員的深入研究和評估,以確保患者得到適當的處理和管理。

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原文英:

Cortex. 2023 Oct:167:218-222. doi: 10.1016/j.cortex.2023.06.020. Epub 2023 Jul 24.

Alice in wonderland syndrome "through the looking-glass" in a rare presentation of non-convulsive status epilepticus in cerebral venous sinus thrombosis and COVID-19

M Biggi 1, M Contento 2, M Magliani 1, G Giovannelli 3, A Barilaro 3, V Bessi 1, I Lombardo 4, L Massacesi 5, E Rosati 6

Affiliations expand

PMID: 37572532 DOI: 10.1016/j.cortex.2023.06.020

Abstract

Alice in Wonderland Syndrome (AIWS) is a rare perceptual disorder, rarely associated with epileptic etiology. We report the case of a 23-year-old man with subacute onset of right peri-orbital headache and visual misperceptions consistent with AIWS Type B, who underwent laboratory tests, brain CT with venography, ophthalmic examination, and neurological assessment that turned out to be normal except for visuospatial difficulties and constructional apraxia. A nasopharyngeal SARS-CoV2 swab taken as screening protocol was positive. The EEG performed because of the persistence of AIWS showed a focal right temporo-occipital non-convulsive status epilepticus; a slow resolution of clinical and EEG alterations was achieved with anti-seizure medications. Brain MRI showed right cortical temporo-occipital signal abnormalities consistent with peri-ictal changes and post-contrast T1 revealed a superior sagittal sinus thrombosis, thus anticoagulant therapy was initiated. AIWS is associated with temporo-parieto-occipital carrefour abnormalities, where visual and somatosensory inputs are integrated to generate the representation of body schema. In this patient, AIWS is caused by temporo-occipital status epilepticus without anatomical and electroencephalographic involvement of the parietal region, consistent with the absence of somatosensory symptoms of the syndrome. Status epilepticus can be the presenting symptom of cerebral venous sinus thrombosis (CVST) which, in this case, is possibly due to the hypercoagulable state associated with COVID-19.


Keywords: Alice in wonderland syndrome; COVID-19; Cerebral venous sinus thrombosis; Focal onset epilepsy; Non-convulsive status epilepticus; Temporo-occipital seizures.


Copyright © 2023 Elsevier Ltd. All rights reserved.