Postictal diffusion abnormalities of the thalamus in subacute encephalopathy and seizures in alcoholics (SESA)

Abstract

Subacute encephalopathy with seizures in chronic alcoholism (SESA) often presents with confusion, seizures, and focal neurological deficits. We herein report a case of SESA with thalamic lesion on MRI taken after status epilepticus in a patient having a typical alcohol withdrawal seizure. A 58-year-old woman with a history of chronic alcoholism was admitted for motor onset seizures, status epilepticus, and confusion thought to be secondary to an alcohol withdrawal seizure. After starting levetiracetam, her mental status and left hemiparesis were resolved, and she was dis-charged from the hospital. She resumed drinking and discontinued her medication. Two months after discharge, she experienced recurrent epileptic seizures and was readmitted due to psychiatric symptoms. SESA is a rare clinical syndrome for which an accurate diagnosis is critical, since MRI examination and continuous EEG monitoring are recommended for suspicious cases. Patients may also require long-term treatment with antiepileptic drugs to prevent recurrence.