Transient Gyral Enhancement After Epileptic Seizure in a Patient with CREST Syndrome/CREST Sendromlu Bir Olguda Epileptik Nobet Sonrasi Gelisen Gecici Giral Kontrastlanma

• Published in: Türk nöroloji dergisi Vol. 23; no. 4; p. 229
• Main Authors: Acikgoz, Mustafa, Demirel, Esra Aciman, Gudul, Serdar, Celebi, Ulufer, Ozkal, Birol, Atasoy, Huseyin Tugrul
• Format: Journal Article
• Language: English
• Published: Galenos Yayinevi Tic. Ltd 01.12.2017
• Subjects: Antibodies; Diagnosis; Electroencephalography; Epilepsy; Health aspects; Scleroderma (Disease); Seizures (Medicine)
• ISSN: 1301-062X; 1309-2545
• DOI: 10.4274/tnd.27048

Limited scleroderma, also termed CREST syndrome (calcinosis cutis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia), is a form of scleroderma which is an autoimmune connective tissue disease. Neurological involvement is less common than other system involvements in scleroderma. Epileptic seizure is a rare neurological complication. Gyral enhancement is not an expected finding during disease. Gyral enhancement is contrast enhancement of superficial brain parenchyma and it usually occurs as a result of vascular, inflammatory, infectious and neoplastic processes. A-sixty-seven-year old female patient, who was diagnosed as CREST syndrome for three years was admitted to our hospital. She had an epileptic seizure three days ago and behavioral changes after the seizure. There was not epilepsy diagnosis in her medical history. In neurological examination; she was apathic and deep tendon reflexes were hyperactive, Hoffman's and Babinski reflexes were positive on the right side of her body. In laboratory studies; anti-nuclear antibody was positive at 1/1000 and anti-centromere antibody was positive. On contrast-enhanced cranial magnetic resonance imaging (MRI); gyral enhancement was observed in the left parieto-occipital region. Cerebrospinal fluid tests were within normal limits. Electroencephalography demonstrated diffuse cerebral dysfunction. We administrated antiepileptic drug to the patient during hospitalization. On the follow up, apathy and restriction of the cooperation were improved. Epileptic seizure did not recur. After ten days, in the control cranial MRI, gyral enhancement was reduced significantly. Neurological involvement in CREST syndrome is rare and epileptic seizures have been appeared in a limited number in the literature. Inflammatory and vascular processes can cause gyral enhancement, but also it must be kept in mind that gyral enhancement can be observed transiently after epileptic seizure. Keywords: CREST syndrome, epileptic seizure, gyral enhancement Oz Sinirli skleroderma; otoimmun bag dokusu hastaligi olan sklerodermanin bir formudur ve CREST sendromu (kalsinozis kutis, Raynaud fenomeni, ozefageal dismotilite, sklerodaktili ve telenjiektazi) olarak da adlandirilir. Sklerodermada norolojik tutulum diger sistem tutulumlarina gore daha az gorulur. Epileptik nobet ise nadir gorulen norolojik komplikasyonlardandir. Hastalikta giral kontrastlanma beklenen bir bulgu degildir. Giral kontrastlanma, beyin parankiminin yuzeyel kontrast tutulumudur ve genellikle vaskuler, enflamatuvar, enfeksiyoz ve neoplastik surecler sonucu ortaya cikar. Uc yildir CREST sendromu tanisi olan 67 yasinda kadin hasta hastanemize basvurdu. Uc gun once epileptik nobet gecirmisti ve nobet sonrasinda davranis degisiklikleri mevcuttu. Ozgecmisinde epileptik nobet hikayesi yoktu. Norolojik muayenesinde; apatikti ve kooperasyonu kisitli idi. Derin tendon refleksleri yaygin olarak artmisti, sagda Hoffman ve Babinski refleksleri pozitifti. Laboratuvar incelemelerinde anti-nukleer antikor pozitifti (1/1000) ve anti-sentromer antikor pozitifti. Kontrastli kraniyal manyetik rezonans goruntulemede (MRG) sol paryeto-oksipital bolgede giral kontrast tutulumu izlendi. Beyin omurilik sivisi tetkikleri normal sinirlarda idi. Cekilen elektroensefalografide; diffuz serebral disfonksiyon gozlendi. Yatisinda hastaya antiepileptik tedavi baslandi. Takipte hastanin apatisi ve kooperasyon kisitliligi duzeldi. Nobeti tekrarlamadi. On gun sonra cekilen kontrol kontrastli kraniyal MRG'de giral kontrastlanmanin buyuk olcude azaldigi gozlendi. CREST sendromunda norolojik tutulum nadirdir ve hastalik seyrinde epileptik nobet gozlenmesi literaturde sinirli sayida yer almistir. Giral kontrastlanma vaskuler ve enflamatuvar sureclere ikincil olarak ortaya cikabilmektedir fakat epileptik nobet sonrasi gecici olarak gozlenebildigi de akilda tutulmalidir. Anahtar Kelimeler: CREST sendromu, epileptik nobet, giral kontrastlanma