Recurrent dysphasic status epilepticus: a case with an unusual clinical course

During 1 year an 83-year-old male, with an unremarkable past medical history, was admitted six times with sudden onset of a prolonged language disorder consistent with fluent dysphasia. Showing no neurological sequelae after the first two hospitalizations, he developed an increasing residual deficit in the course of each consecutive episode. MRI studies showed repeatedly a small venous cavemoma in the left parieto-occipital region and no progressive vascular changes. Periodic lateralized epileptiform discharges (PLEDs) with temporo-occipital maximum and, at the last hospital stay, a transient sharp-slow-wave focus were noted. Tc-SPECT study in the acute phase revealed a temporal and parieto-occipital hyperperfused area changed to hypoperfusion after a week. Reversible ischaemic neurological deficit was diagnosed initially. PLEDs, epileptogenic focus, hyperaemic SPECT study and aspects of the clinical course suggest the diagnosis of symptomatic nonconvulsive simple partial status epilepticus. In this context the increasing residual deficit remains to be discussed.