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Hypsarhythmia-infantile spasms in near-drowning: clinical, EEG, CT scan and evoked potential studies
S Ganji1, A C Tilton, L Happel
1Department of Neurology, LSU Medical Center, New Orleans 70112.
Insights
Near drowning in a 13-month-old led to infantile spasms and hypsarrhythmia. Brain imaging showed tract disruption and ventricular dilation, suggesting cortical deafferentiation may cause these spasms.
Area of Science:
- Neuroscience
- Pediatric Neurology
- Clinical Electrophysiology
Background:
- Infantile spasms are a severe epilepsy syndrome in infants.
- Near-drowning incidents can cause significant hypoxic-ischemic brain injury.
- Understanding the mechanisms of acquired epilepsy is crucial for treatment.
Observation:
- A 13-month-old child experienced near-drowning.
- Following the event, the child developed hypsarrhythmia and infantile spasms.
- EEG revealed hypsarrhythmia, while CT and evoked potentials showed brainstem tract disruption and ventricular dilation.
Findings:
- Hypsarrhythmia and infantile spasms were diagnosed post-near drowning.
- Brain imaging demonstrated disruption of ascending/descending tracts and significant ventricular/subarachnoid space dilation.
- These findings suggest a link between severe brain injury and epileptic encephalopathy.
Implications:
- Cortical deafferentiation may play a critical role in the development of hypsarrhythmia after brain injury.
- This case highlights the potential for severe neurological sequelae following non-fatal drowning.
- Further research into the pathophysiology of acquired infantile spasms is warranted.
Abstract:
A 13-month-old child developed hypsarhythmia-infantile spasms after nearly drowning. Serial EEG, multimodality evoked potential, and CT scan of the brain revealed hypsarhythmia, disruption of ascending and descending tracts rostral to the mesencephalon, and a fairly severe degree of dilation of the ventricular system and subarachnoid space. We speculate that deafferentiation of the cerebral cortex is critical in the genesis of the hypsarhythmic pattern.