Zusammenfassung
Ein mit einem progredienten Verwirrtheitszustand bei akutem Beginn extern zugewiesener
Patient (66 Jahre) war unter Behandlung mit Haloperidol hinsichtlich der Verwirrtheit
progredient.
Das EEG zeigte ein kontinuierliches Anfallsmuster im Sinne eines nonkonvulsiven Status
epilepticus. Unter Therapie mit Lorazepam und Valproat sistierte der Status, jedoch
ergab sich der Verdacht einer Valproatenzephalopathie. Unter Topiramat besserten sich
die Symptome, dennoch persistierten fluktuierend ausgeprägte kognitive und mnestische
Störungen auf dem Boden einer vaskulären Demenz.
Abstract
We report about a patient (66 years) who was referred to our psychiatric hospital
because of a progressive confusional state with acute onset. The colleagues of the
referring psychiatric hospital considered a first manic episode as the cause of the
symptoms and under therapy with haloperidol the confusional state had shown a progression.
The clinical examination’s findings were a mild central facial paresis on the right
side and a mild hemiparesis on the right side with elevated reflex levels.
The patient was disoriented, he had cognitive and mnestic deficits. His reasoning
was slowed, incoherent and perseverating. The patient had a slight euphoria.
An EEG recording showed a continuous regional EEG-seizure pattern. In combination
with the clinical symptoms we diagnosed a nonconvulsive status epilepticus. Under
anticonvulsive treatment with Lorazepam and Valproic acid the status epilepticus sustended
but a control EEG recording showed signs of a Valproate-encephalopathy. Under treatment
with Topiramate symptoms ameliorated but due to a vascular dementia the patient still
showed fluctuating symptoms of cognitive and mnestic disturbances.
Schlüsselwörter
Delir - Status epilepticus - Demenz
Keywords
delirium - status epilepticus - dementia
