Glioblastoma in the limbic system presenting as sustained central hypopnea

• Published in: Interdisciplinary neurosurgery : Advanced techniques and case management Vol. 7; no. C; pp. 62 - 63
• Main Authors: Mashiko, Ryota, Shibata, Yasushi, Ishikawa, Eiichi, Fujimoto, Ayataka
• Format: Journal Article
• Language: English
• Published: Elsevier 01.03.2017
• Subjects: Epilepsy; Glioblastoma; Hypopnea; Limbic system; Medical Education; Neurosurgery; Nonconvulsive status epilepticus; Limbic system; Hypopnea; Nonconvulsive status epilepticus; Epilepsy; Glioblastoma
• ISSN: 2214-7519; 2214-7519
• DOI: 10.1016/j.inat.2016.12.003

Abstract A 71-year-old woman was transferred to our hospital after experiencing an epigastric sensation followed by unconsciousness. On arrival, the patient showed impaired consciousness without convulsive movement, cyanosis and shallow breathing, arterial O2 desaturation, and increased PCO2 . Artificial respiration improved CO2 accumulation and consciousness, but interruption of artificial respiration returned the patient to her former state. Computed tomography of the head showed a mass around the left corpus callosum. The patient's hypopnea followed by unconsciousness suggested sustained nonconvulsive epilepsy manifesting in central hypopnea and subsequent unconsciousness due to CO2 narcosis. Intravenous (IV) anticonvulsants promptly improved the respiratory condition, and the patient started to regain consciousness. Magnetic resonance imaging revealed a lesion involving the bilateral limbic systems. To our knowledge, limbic seizure manifesting with hypopnea causing unconsciousness due to CO2 narcosis has not previously been reported, despite evidence of a strong relationship between the limbic and respiratory systems. The current case suggests that sustained limbic seizure can manifest as hypopnea. Since emergency EEG can be difficult to perform, IV anticonvulsant treatment is an appropriate diagnostic therapy.