2015 Volume 27 Issue 3 Pages 53-57
We report two elderly cases of NCSE manifested by coma. Case 1: A 91-year-old man was admitted for impaired consciousness. Then he fell into coma four days later. Hippus and facial myoclonus-like movement were noted in the emergency room (ER). Following head MRI and EEG, he was diagnosed with limbic encephalitis with NCSE. Despite treatment with AEDs, his symptoms did not improve. Subsequent MRI revealed marked gyriform cortical hyperintensity throughout the brain. Case 2: A 77-year-old woman was admitted to Toyooka hospital 10 hours after onset of coma. Facial myoclonus-like movement and nystagmoid eye movement were noted while she was in ER. Following head MRI and EEG, she was diagnosed with NCSE. Her symptoms rapidly improved after treatment with AEDs. As in GCSE, the longer NCSE persists, the more difficult it is to treat and the higher the mortality rate. Therefore, it is important that NSCE is diagnosed and treated as soon as possible. For this to occur, it is necessary to note involuntary facial movements and ocular abnormalities in comatose patient without convulsion, especially in the elderly. EEG is required to confirm the diagnosis.
