Abstracts

Rationale: Nonconvulsive status epilepticus is a disorder with different prognosis due to the underlying etiology. It is recognized increasingly as a cause of altered mental status or coma and accounts for 25% of all cases of status epilepticus (Treiman et al.,1998). NCSE is diagnosed only by continuous electroencephalogram monitoring. Methods: Case report Results: A 75-year old female patient visited our emergency department with altered mental status. The patient was taking medication for hypertension and acute gastritis. Four days before the onset of the symptom, due to nausea, the patient could hardly eat. Except for drowsy mental status, there were no other neurological deficit. Initial CSF study was done. The CSF was clear and colorless. The intracranial pressure was 210 mm Hg. The result showed elevated leukocyte count and protein with low CSF-to-serum glucose ratio. The electroencephalogram(EEG) showed nonconvulsive status epilepticus, which could be suspected as a result of autoimmune encephalitis. Thus, antiepileptic treatment for NCSE was started.Through further evaluation, there was a lesion of suspected primary lung cancer in chest Computed Tomography. Bronchoscopy was done for cytology, but, due to the site of the lesion, the exam had a possibility of failure and no malignant cell was detected in bronchial washing cytology. In CSF cytopathology, malignancy was confirmed. Autoimmune synaptic encephalitis antibodies(NMDAR, AMPA1/2, LGI1, CASPR2, GABA-B) and paraneoplastic syndrome antibodies(anti-Hu, anti-Yo, anti-Ri, anti-PNMA2(Ma2/Ta), CV2/CRMP5, anti-amphiphysin, anti-Recoverin, anti-Titin(MGT-30) ) were all negative and anti-SOX1 was positive. The brain magnetic resonance image(MRI) showed diffuse meningeal enhancement.Despite the use of benzodiazepine continuous infusion treatment and burst-suppression was achieved in EEG, the patient was unresponsive to first intrathecal chemotherapy and expired two days later. Conclusions: This was the case of nonconvulsive status epilepticus due to leptomeningeal carcinomatosis with unconfirmed primary cancer. And a case with poor prognosis who died after first treatment of intrathecal chemotherapy. Funding: None