Abstracts

Rationale: Few reports has been published describing visual symptoms as the cardinal manifestation of Status Epilepticus (SE) in adults. Objective:Describing semiology, electoencephalographic features (EEG), and outcome in a group of patients with diagnosis  of Focal Visual SE (FVSE). Methods: Retrospective review of clinical records of patients evaluated by neurology in the emergency department, who consulted because of visual symptoms, achieving final diagnosis of FVSE, between 01-2010 and 12-2014. Results: Eight patients were identified fulfilling inclusion criteria, with median age 64 yo (20-76 yo), 6 were male. Three patients had epilepsy history. Median time from clinical onset to diagnosis was  3 days (0.5-20 days). Semiology frequency was Hemianopsia or eschotomas: 76% (6 patients); headache  62% (5 patients); simple visual hallucinations: 50% (4 patients); complex visual hallucinations (25% (2 patients); abnormal eye movements: 25% (2 patients); alteration consciousness: 25% (2 patients); focal sensitive symptoms: 25% (2 patients); other (neglect, motor symptoms: 10% (1 patient). Epilepsy syndrome was structural in 4 patients, and of unknown cause in the rest. EEG findings were consistent with focal SE in posterior brain regions in 5 patients, in 2 patients EEG was positive only for theta or delta intermittent activity with sharp waves superimposed in the same areas, and 1 patient evidenced 0.5-1 Hz periodic lateralized discharges in posterior area. Although 5 patients evolved to refractory SE, all resolved with anticonvulsive treatment , and none of them required sedation. Long term follow up (median 20 months): 2 patients relapsed with FVSE, 1 continued with isolated focal visual seizures, 1 was lost to follow up, and the rest did not repeat epileptic events. Conclusions: We described 8 patients with diagnosis of FVSE, 6 of them without epilepsy history. Negative visual symptoms and headache were the most frequent clinical manifestation (76% and 62% of cases), followed by simple visual hallucinations, then complex visual hallucinations, abnormal level of consciousness and sensitive phenomenon. All patients responded to anticonvulsive treatment, without sedation requirement. Funding: No funding was received in support of this abstract.