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Cryptococcal meningitis manifesting as epilepsia partialis continua of the abdomen
C H Chalk1, P G McManis, G D Cascino
1Department of Neurology, Mayo Clinic, Rochester, MN 55905.
Abstract:
We report a case of epilepsia partialis continua that primarily involved the abdominal muscles. Thorough assessment ultimately showed that the condition was due to cryptococcal meningitis. Surface electrode electromyography and electroencephalography were helpful in analyzing this unusual epileptic phenomenon. An 8-week treatment regimen of amphotericin B and a 30-day course of 5-fluorocytosine abolished the epilepsia partialis continua and cured the meningitis. This case should alert physicians to the fact that patients with epilepsia partialis continua may have clonic movements of only the trunk and that the spectrum of neurologic manifestations of cryptococcal infection must now include this seizure disorder.
Insights
Epilepsia partialis continua, a rare seizure disorder, can manifest solely in abdominal muscles. This case highlights cryptococcal meningitis as a cause, treatable with antifungal therapy.
Area of Science:
- Neurology
- Infectious Diseases
Background:
- Epilepsia partialis continua (EPC) is a rare focal epilepsy characterized by continuous focal motor seizures.
- Neurological manifestations of cryptococcal infections are diverse, but EPC is not a commonly recognized feature.
Observation:
- A patient presented with EPC primarily involving abdominal muscles.
- Diagnostic workup revealed cryptococcal meningitis as the underlying cause.
- Surface electrode electromyography (sEMG) and electroencephalography (EEG) aided in characterizing the unusual epileptic activity.
Findings:
- Successful treatment of cryptococcal meningitis with amphotericin B and 5-fluorocytosine led to the resolution of EPC.
- This demonstrates the efficacy of antifungal therapy in managing EPC secondary to fungal meningitis.
Implications:
- Physicians should consider EPC involving only the trunk muscles in their differential diagnosis.
- Cryptococcal meningitis should be recognized as a potential cause of EPC, expanding the spectrum of its neurological presentations.