Document Detail

Protracted ictal confusion in elderly patients.
MedLine Citation:
PMID:  16606764     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Ictal confusion, particularly if protracted, often presents a diagnostic challenge. OBJECTIVES: To define protracted ictal confusion in elderly patients and to characterize its features and outcome. DESIGN: Case series. SETTING: Neurology outpatient and emergency departments at 2 tertiary care centers. PATIENTS: Consecutive series of 22 ambulatory patients with acute ictal confusion. MAIN OUTCOME MEASURES: Duration of ictal confusion was correlated with age and lesions noted on cerebral images and videoelectroencephalographic studies. RESULTS: The ictal basis underlying confusion was not recognized for up to 5 days in 22 patients (mean +/- SD age, 70 +/- 8.5 years). Twenty patients had partial complex status epilepticus, and 2 patients had newly diagnosed primary generalized status epilepticus. Motor movements were not present in either group, although reduced mood states and ictal neglect were noted in some patients. Fifteen patients had previous episodes (2-10) of protracted ictal confusion. Once identified, treatment reversed confusion, and eventually patients were discharged to home, although a few patients sustained persistent reduction in baseline cognition. CONCLUSIONS: Protracted ictal confusion is often not considered in the ambulatory elderly patient, with resulting delay in diagnosis. Electroencephalographic and videoelectroencephalographic studies performed while the patient is experiencing symptoms are crucial to early diagnosis and timely management.
Raj D Sheth; Joseph F Drazkowski; Joseph I Sirven; Barry E Gidal; Bruce P Hermann
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of neurology     Volume:  63     ISSN:  0003-9942     ISO Abbreviation:  Arch. Neurol.     Publication Date:  2006 Apr 
Date Detail:
Created Date:  2006-04-11     Completed Date:  2006-05-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372436     Medline TA:  Arch Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  529-32     Citation Subset:  AIM; IM    
Department of Neurology, University of Wisconsin-Madison, 600 Highland Avenue, Box H6/574 CSC, Madison, WI 53792-5132, USA.
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MeSH Terms
Age Factors
Anticonvulsants / therapeutic use
Atrophy / complications,  diagnosis
Brain / pathology,  physiopathology*,  radiography
Cerebrovascular Disorders / complications,  diagnosis
Chronic Disease / drug therapy
Cognition Disorders / diagnosis,  drug therapy,  physiopathology
Confusion / diagnosis*,  drug therapy,  physiopathology*
Early Diagnosis
Magnetic Resonance Imaging
Middle Aged
Predictive Value of Tests
Status Epilepticus / diagnosis*,  drug therapy,  physiopathology*
Tomography, X-Ray Computed
Treatment Outcome
Reg. No./Substance:

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