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Abstract Details

A case of isolated and prolonged aphasic status epilepticus
Epilepsy/Clinical Neurophysiology (EEG)
P4 - Poster Session 4 (5:30 PM-6:30 PM)
12-007
To report a case of sudden onset isolated and prolonged aphasic status epilepticus
Sudden onset of aphasic status epilepticus is a rare condition that mimics stroke. For patients presenting with acute onset isolated language impairment, epileptic aphasia or aphasic status epilepticus should be considered. Patients with aphasic status epilepticus may retain some aphasic deficits for several days or even weeks after the ictal EEG pattern has resolved. 
Case report
A 78 years old man was found confused in the bathroom by co-workers. Upon presentation in the emergency room, he was found to have global aphasia without impaired awareness. He was not able to comprehend simple instructions and had severe effortful expressive deficits producing only single simple words. MRI brain showed focal linear water restriction alongside the cortical band in left posterior insular cortex and the left posterior temporal cortex. vEEG was performed the next day which showed sharp waves in the left frontal temporal region with phase reversal in F3, F7, as well as brief bursts of rhythmic theta activity in the L temporal region which was consistent with electrographic seizure activities. Keppra 500 mg bid was started on hospital Day#2. Although electrographic seizure activities improved gradually over days during the hospital stay, only mild clinical improvement was achieved upon discharge.
In patients presenting with isolated and prolonged language impairment, particularly with liner pattern of DWI restriction changes alongside the cortical band, epileptic aphasia or aphasic status epilepticus should be considered. Similar to our patient, previous case reports revealed that patients with epileptic aphasia may retain some aphasic deficits for several days or even weeks after the ictal EEG pattern has resolved. It is not clear if the slow recovery is the result of a prolonged postictal “Todd’s” phenomenon or ongoing seizures not detectable on scalp electrodes. 
Authors/Disclosures
Chen Chen, MD
PRESENTER 		No disclosure on file
David A. Marks, MD Dr. Marks has nothing to disclose.