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Kinesigenic dyskinesias after ENT surgery misdiagnosed as focal epilepsy
  1. Selina Denise Trapp1,
  2. Soheyl Noachtar2 and
  3. Elisabeth Kaufmann1
  1. 1Neurology, Faculty of Medicine, Ludwig Maximilians University Munich, Munich, Germany
  2. 2Epilepsy Center, Department of Neurology, University of Munich, Muenchen, Germany
  1. Correspondence to Ms Selina Denise Trapp; selina.trapp{at}med.uni-muenchen.de

Abstract

We describe a man in his 30s who presented with paroxysmal right-sided dyskinesias of the arm and neck, misdiagnosed with drug-resistant focal epilepsy. Two months earlier he had undergone surgery for chronic sinusitis. Immediately after this procedure, he developed hemiparesis, hemiataxia, paresthesias and disturbances in verbal fluency. Cranial MRI revealed a disruption of the left lamina cribrosa and an intracerebral injury resembling a branch canal spanning to the left dorsal third of the thalamus. Single-photon emission tomography imaging demonstrated malperfusion of the left ventral thalamus, left-sided cortex and right cerebellar hemisphere. During continuous video-EEG monitoring, three dyskinetic episodes with tremor of the right arm and dystonia of the finger and shoulder could be recorded. The paroxysmal dyskinesias did not improve with carbamazepine, valproate and tiapride. This case demonstrates an unusual symptomatic cause of a thalamic movement disorder misdiagnosed as focal epilepsy and highlights the postoperative complications, diagnostic and treatment efforts.

  • neurology (drugs and medicines)
  • neurology
  • epilepsy and seizures
  • movement disorders (other than Parkinson's)
  • neurological injury

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Footnotes

  • Contributors SDT prepared the manuscript draft and the figures. EK and SN revised the manuscript critically for intellectual content. SN evaluated and treated the patient. All authors made substantial contributions to the conception of the work and gave the final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests EK and SDT have no conflict of interest. SN reports personal fees from Desitin, UCB Pharma, Medtronic, Eisai and Zogenix.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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