An invisible enemy. Echoacousis and aphasia as a rare presentation of a non convulsive status epilepticus

Abstract

Status epilepticus is not always an easily recognised condition, which can become a cause of serious consequences, and even death. It can present in two clinical forms: convulsive and nonconvulsive. The clinical symptoms representing nonconvulsive status epilepticus (NCSE) can vary a lot and sometimes be very misleading. We present here a case of a woman, who is a carrier of 6 platinum spirals as a result of endovascular aneurysm embolisation and has undergone a surgery for the removal of the left temporal lobe meningioma. The patient showed the signs of sensorimotor aphasia and echoacusis in the early postoperative period. Taking into account the past history of a tonic-clonic seizure and inability to perform EEG during the clinical manifestations, the diagnosis of NCSE was done clinically, and the treatment started immediately with the IV diazepam and valproic acid administration, leading to complete resolution of aphasia and echoacusis. Negative neurological clinical symptoms are rare in the presentation of epilepsy, and echolalia is not yet described as a symptom of a NCSE. In our case the patient presents with the combination of these two symptoms, which can make the diagnosing even more challenging. This case report aims to highlight the variety of clinical symptoms which can represent NCSE and prompt early diagnosis and treatment, avoiding life threatening consequences.