BACKGROUND: Changes in levels of trace elements have been proposed to underlie febrile seizures. Particularly, low zinc levels have been proposed as related factor of febrile seizure. In this study, we investigated whether mean serum zinc levels differed between children with febrile seizure and afebrile seizure. METHODS: Using inductively coupled plasma mass spectrometry, serum zinc levels were measured in 288 children who had been diagnosed with febrile seizures (N=248) and afebrile seizures (N=40). Mean serum zinc levels were compared between the 2 groups. RESULTS: Mean serum zinc level was 60.5+/-12.7 microg/dL in the febrile seizure group and 68.9 +/-14.5 microg/dL in the afebrile seizure group. A significant difference in serum zinc levels was observed between the febrile and afebrile seizure groups (P<0.001). CONCLUSIONS: Zinc levels in children with febrile seizure were significantly lower than those in children with afebrile seizure.
Child, Preschool ; Female ; Humans ; Infant ; Male ; *Mass Spectrometry ; Seizures/blood/*diagnosis ; Seizures, Febrile/blood/*diagnosis ; Zinc/*blood

Hyperinsulinemic hypoglycemia is a relatively rare disease in childhood period except neonate, but hypoglycemia due to delicate imbalance between glucose production & consumption is evoked easily and left permanent damage to brain at these period. The definition is that serum insulin level is above 10microU/ml when blood sugar level is below the 40mg/dl and so I/G ratio is higher than 0.4. The clinical manifestations are irrtability, frequent feeding and seizures etc. and there is no specific pancreatic pathology in most cases. We experienced 2 cases of hyperinsulinemic hypoglycemia with pancreatic hyperplasia and pancreatic adenoma each other. The diagnosis was made on clinical manifestations, laboratory results, radiologic and pathologic findings. We reported these cases with brief review of literature.
Adenoma ; Blood Glucose ; Brain ; Diagnosis ; Glucose ; Humans ; Hyperplasia ; Hypoglycemia* ; Infant, Newborn ; Insulin ; Pathology ; Rare Diseases ; Seizures

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state with distinct clinical and radiological features. It is characterized by headache, vomiting, altered mentality, seizures, and visual disturbances. PRES typically consists of reversible vasogenic edema in the posterior circulation territories, although irreversible cytotoxic edema and atypical lesion locations have also been described. Most patients are markedly hypertensive at presentation, although some have only mildly elevated or even normal blood pressure. Many known causative factors of PRES have been elucidated, but its underlying pathophysiology remains poorly defined. This review summarizes the etiologies, presumed pathophysiology, histopathologic findings, basic and advanced imaging features, clinical symptoms of presentation, and treatment of PRES.
Blood Pressure ; Diagnosis, Differential ; Edema ; Headache ; Humans ; Posterior Leukoencephalopathy Syndrome* ; Seizures ; Vomiting

Pheochromocytoma crisis is a life-threatening endocrine emergency. Stimuli that can elicit a pheochromocytoma crisis include anesthesia, tumor manipulation, and several drugs. Rarely, glucocorticoids can induce a pheochromocytoma crisis. Here, we describe the case of a 65-year-old female who developed an adrenergic crisis with blood pressure fluctuations, dizziness, and seizures after receiving glucocorticoids for the treatment of urticaria. The symptoms led us to speculate that a pheochromocytoma was present. We confirmed the diagnosis based on abdominal imaging and biochemical studies. The patient's symptoms improved after surgical removal of the pheochromocytoma.
Aged ; Anesthesia ; Blood Pressure ; Diagnosis ; Dizziness ; Emergencies ; Female ; Glucocorticoids ; Humans ; Pheochromocytoma* ; Seizures ; Urticaria*

Idiopathic hypertrophic cranial pachymeningitis(IHCP) is a rare chronic pro gressive fibrosing inflammation of pachymeninges of unknown origin. Since the spreading of CT and MRI, there has been a few cases of IHCP have been reported. We describe two patients of IHCP with brain parenchymal involvement presented as epilepsia partialis continua which has not been described as a symptom of IHCP and review the previous reported literatures. IHCP commonly presents headache, multiple cranial nerve palsy, ataxia, and sometimes seizure. In many cases, the CSF finding is noninfectious inflammation, and the erythrocyte sedimentation rate is elevated. The brain MRI is the best noninvasive tool for diagnosis of IHCP and shows diffuse thickening and enhancing dura, especially posterior fossa. IHCP responds steroid initially but recurs frequently and progresses chronically.
Ataxia ; Blood Sedimentation ; Brain ; Cranial Nerve Diseases ; Diagnosis ; Epilepsia Partialis Continua ; Headache ; Humans ; Inflammation ; Magnetic Resonance Imaging ; Meningitis* ; Seizures

A 13-year-old, spayed, female Chihuahua dog was referred for evaluation of fever, lethargy, and dyspnea. Hematologic evaluation revealed severe neutropenia, thrombocytopenia, and mild anemia. The dog had been undergoing phenobarbital therapy for the past 7 weeks because of generalized seizures due to meningoencephalomyelitis of unknown etiology. After ruling out other possible causes of cytopenias, a tentative diagnosis was made of drug-induced blood cell dyscrasia. The neutropenia and thrombocytopenia resolved after discontinuation of phenobarbital (8 days and 15 days after discontinuation, respectively). This is the first case report in Korea to demonstrate blood dyscrasia associated with idiosyncratic adverse effects of phenobarbital.
Adolescent ; Anemia ; Animals ; Blood Cells* ; Diagnosis ; Dogs* ; Dyspnea ; Female ; Fever ; Humans ; Korea ; Lethargy ; Leukopenia ; Neutropenia ; Phenobarbital* ; Seizures ; Thrombocytopenia

Posterior reversible encephalopathy syndrome (PRES) is characterized by headache, vomiting, confusion, and seizure. In addition, PRES is associated with reversible bilateral cortical and subcortical edema on occipital lobe or parieto-occipital lobe. Eclampsia is a rare condition to pregnant and puerperal women and one of common causes of the PRES. The clinical and radiologic manifestations can be resolved without irreversible complication by early diagnosis and appropriate treatment. The authors report a case of eclamptic encephalopathy associated with PRES, in which an 18-year-old woman had clinical manifestations of visual disturbance, headache, and tonic-clonic seizure at 34 hours after vaginal delivery. High signal intensities are seen in both parieto-occipital lobes and left basal ganglia on fluid attenuated inversion recovery (FLAIR) images and T2 weighted images performed at emergency room. But no significant signal change in both parieto-occipital lobes on diffusion weighted images (DWI). Because seizure was repeated, then anticonvulsant was administered at intensive care unit. On the second day, the clinical manifestations were resolved as blood pressure was normalized. The FLAIR imaging and DWI sequences can play an important role in the diagnosis of PRES.
Adolescent ; Basal Ganglia ; Blood Pressure ; Diagnosis ; Diffusion ; Early Diagnosis ; Eclampsia ; Edema ; Emergency Service, Hospital ; Female ; Headache ; Humans ; Intensive Care Units ; Occipital Lobe ; Posterior Leukoencephalopathy Syndrome* ; Pregnancy ; Seizures ; Vomiting

INTRODUCTIONSeizure is the most common paediatric neurological disease which occurs in ten percent of children. In approaching a convulsive patient, finding the causes of seizure is essential, and the patient's history as well as the physical examination are important. The role of routine laboratory tests for children's seizures (except neonates) is undetermined, but checking for serum sodium, glucose, calcium and urea routinely has been advised. The purpose of this study was to determine the diagnostic efficacy of these serum chemistry tests in the seizures of children older than one month of age.

METHODSIn this descriptive, retrospective study, medical records of 302 hospitalised children with seizure were reviewed. Results of laboratory tests, like sodium, calcium, blood glucose and urea levels, pertinent history and physical examination, and the change in patient management based on serum chemistry test results, were analysed. All the children in the study were classified as having seizure with or without fever.

RESULTSIn 302 hospitalised children with seizure, about ten percent of 938 tests were abnormal. 27.7 percent of these abnormal results were seen in 1-12-month-old infants. Only 11 percent of abnormal tests (1.3 percent of total tests) might have caused a seizure. Also, 0.2 percent of the results could not be predicted from the history or physical examination, which was conducted in patients younger than one year of age.

CONCLUSIONRoutine determination of serum chemistry values in seizures of children does not contribute to therapy, and are costly and time-consuming. It may not be helpful and informative unless the patient is less than one year of age.

Blood Chemical Analysis ; methods ; Calcium ; blood ; Chemistry, Clinical ; methods ; Child ; Child, Preschool ; Female ; Glucose ; biosynthesis ; Humans ; Infant ; Male ; Retrospective Studies ; Seizures ; blood ; diagnosis ; Sodium ; blood ; Treatment Outcome ; Urea ; blood

We experienced a case of cerebral hypoperfusion due to cyclosporine neurotoxocity confirmed only by Tc-99m ECD brain SPECT. A 53-year-old female had received allogenic peripheral blood stem cell transplantation due to refractory plasmacytoid lymphoma. Cyclosporine and steroid had been administrated to prevent graft versus host disease. Twenty days after transplantation, she became delirious and suffered from generalized tonic-clonic seizure. Immediately, brain MRI and MR angiography were performed and these studies did not show any abnormal findings. However, Tc-99m ECD brain SPECT showed diffuse hypoperfusion in the left cerebral hemisphere and blood cyclosporine level was 962.6 ng/ml. Cyclosporine administration was stopped and discontinuation of cyclosporine resulted in disappearance of all neurological symptoms. The same neurological symptoms recurred with cyclosporine re-administration for management of exacerbated graft versus host disease. In this case, Tc-99m ECD brain SPECT proved very helpful in the diagnosis of cycloporine neurotoxicity.
Angiography ; Brain ; Cerebrum ; Cyclosporine* ; Diagnosis ; Female ; Graft vs Host Disease ; Humans ; Lymphoma ; Magnetic Resonance Imaging ; Middle Aged ; Peripheral Blood Stem Cell Transplantation ; Seizures ; Tomography, Emission-Computed, Single-Photon

Insulinoma is the most frequent endocrine tumor of the pancreas and the first of the endocrine-secreting tumor of the gut to be recognized by Nicholls in 1902. Recurrent episodes of hypoglycemia is the main cause of the symptoms and signs which were sweating, pallor, dizziness, habitual change, convulsion and coma. In 1935, Whipple and Frants were described so-called “Whipple's triad”: the patient's symptoms occur with fasting or exercise; at the time of symptoms, the serum glucose in 50mg/dl or less; and the symptoms are relieved by the administration of glucose. While these criteria were timely, they proved to be rather nonspecific and may be found in other conditions that result in fasting hypoglycemia. We experienced a 44-year-old female patient who had repeated attacks of convulsion, unconsciousness and coma for 3 years. Although she has been treated with anticonvulsant, the symptoms and signs were not disappeared. At the time of administration, she was a full coma state due to hypoglycemia and was dramatically reversed by intravenous administration of the glucose solution. The preoperative test such as provocative test, abdominal CT and celiac angiography revealed insulinoma and after enucleation the pathologic diagnosis was the same. We like to report an adult female patient with insulinoma and the review of literatures briefly.
Administration, Intravenous ; Adult ; Angiography ; Blood Glucose ; Coma ; Diagnosis ; Dizziness ; Fasting ; Female ; Glucose ; Humans ; Hypoglycemia ; Insulinoma* ; Pallor ; Pancreas ; Seizures ; Sweat ; Sweating ; Tomography, X-Ray Computed ; Unconsciousness