A 50-Year-Old Woman with Recurrent Generalised Seizures 英文参考文献.docVIP

Learning Forum A 50-Year-Old Woman with Recurrent Generalised Seizures Ronald C. W. Ma , Howan Leung, Patrick Kwan, Wing Yee So, Florence Yap, Chun Chung Chow * D E S C R I P T I O N O F C A S E What Was the Most Likely Diagnosis? A Although the patient had been diagnosed with 50-year-old woman presented in May 2006 with recurrent generalised convulsions. She had a history of hypertension treated with indapamide, but was hypothyroidism shortly prior to her presentation, the abnormal thyroid function tests could not fully explain her neurological state. Repeat serum electrolytes, liver function tests, and calcium and magnesium levels were all normal. Repeat TSH was 11 mIU/l. Computed tomography (CT) of the brain on admission was normal. A lumbar puncture was performed, which showed raised cerebrospinal fluid (CSF) protein 1.5 g/l. The paired CSF–plasma glucose levels were 7.0 mmol/l and 7.1 mmol/l. The CSF cell count, microscopy, and Ziehl-Neelson stain were all otherwise well. Her older sister and mother were known to have thyroid disease. She did not have any history of chronic alcohol use nor any recent history of head injury. The patient had never lived outside of Hong Kong. Prior to admission, she was taken to her general practitioner by her family for gradual onset of decreased alertness, cognitive decline, and reduced verbal communication, which worsened over the course of one week. She was found to have hypothyroidism with TSH (thyroid stimulating hormone) 52.3 mIU/l (normal normal. The opening pressure was 13 cmH 0. Polymerase 2 chain reaction of the CSF was later found to be negative for herpes simplex, enterovirus, and varicella zoster virus DNA. Toxicology screen was negative. Her clinical seizures persisted, and intravenous infusion of propofol/ thiopentone was commenced. Over the subsequent four days, upon withdrawal of propofol and thiopental, the patient still demonstrated altered mental state. The electroenceph