Cerebral artery air embolism following an esophagogastroscopy: a case report.

believe it is important to consider the possibility that prolonged “postictal” deficits may be due to ongoing ictal discharges, as additional anticonvulsant medication may be indicated. There were rare periods in this case when there were subtle pseudoperiodic discharges on the scalp EEG during ongoing ictal activity intracranially, and persistent aphasia. This supports the view that in some instances, periodic lateralized epileptiform discharges (PLED) on the scalp EEG are actually ictal.5 It is possible that functional imaging with PET or SPECT can help make this differentiation, as focal increased blood flow or metabolism during a prolonged postictal deficit or during PLED may suggest an ictal state.6 This was not performed in our patient. We conclude that prolonged “postictal” deficits may sometimes be due to ongoing ictal activity that is not evident on scalp EEG.