(Disclaimer: This article is for scientific use only, and the information in the following content has been processed to protect patient privacy)
Abstract: Epilepsy must be familiar to everyone, and most people think that epilepsy is caused only after trauma. However, epilepsy can also occur in some patients without trauma in clinical practice, as in this case patient, a 20-year-old boy with epilepsy due to smog syndrome. The patient reported frequent severe headaches and sudden onset of epilepsy at the time of consultation, and the final diagnosis of smog syndrome was made through CTA and EEG, and the condition was controlled by surgical treatment + medication with good results.
Basic information】Male, 20 years old
Type of disease】Smoke syndrome
Hospital】Hubei Third People’s Hospital
Date of consultation】October 2020
Treatment plan】Surgical treatment (intracranial artery bypass grafting) + medication (injectable phenobarbital sodium, diazepam injection, sodium valproate extended-release tablets, rivaroxaban tablets)
[Treatment period] 10 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】The treatment effect is good and the disease has been controlled
I. Initial consultation
The patient was a 20-year-old male, accompanied by his parents. The parents described that the patient started to be lazy when he went to university and was not willing to actively prepare for the examination, and always said he had headaches. Patient’s description: He has frequent headaches, and when he has a headache, it is like a knife cut, and he cannot even go to class.
He was considered to have hypertension, and his parents said he had a family history of hypertension. Therefore, the patient was suggested to improve the head CT examination and blood lipid and blood glucose examination.
II. Treatment history
The patient’s head CT report did not show any abnormal lesions. During the visit, the parents suddenly shouted at the patient, who suddenly fell to the ground lopsidedly, and his right foot kept twitching accompanied by twitching of the right eye and corner of the mouth, and was immediately sent to the emergency neurology department, where he was treated with sedative drugs, injectable sodium phenobarbital and diazepam injection. 5 minutes later, the patient’s epilepsy stopped and his confusion returned to normal, and he still felt a left-sided headache.
The patient was recommended to be hospitalized to give EEG monitoring, epileptic waves were detected, and sodium valproate extended-release tablets were given. After communicating with the patient’s mother, CTA (arteriovenous CT angiography) was completed, and the results suggested that the bilateral middle cerebral artery vessels looked like a jumble. The results of the later angiogram suggested smog syndrome. It was clear that the epilepsy was caused by the smoke syndrome. The treatment plan was then adjusted: anticoagulation with rivaroxaban tablets was given, and intracranial artery bypass surgery was recommended after the patient’s symptoms were stabilized. After consultation with the neurosurgeon, the patient’s mother underwent the surgery, and the patient’s epilepsy was completely controlled after the surgery.
(EEG test)
III. Treatment effect
After 10 days of hospitalization, the patient had 3 recurrent seizures, was given sedative symptomatic treatment, and the patient’s twitching stopped after adjusting the dose of oral medication with sodium valproate extended-release tablets, and the EEG recheck was normal. The mother was very remorseful and felt that she had not brought the patient to the clinic earlier. I also introduced this rare cerebrovascular disease to the patient’s mother, the cause of which was not very clear, and angiography was the gold standard for diagnosis, which was difficult to detect in the general population. After consultation with the neurosurgeon, the patient’s mother underwent surgery, and the epilepsy was completely controlled after the surgery. 1 month of outpatient follow-up, the patient reported that the headache symptoms were significantly improved and even disappeared, and now she can study normally.
(EEG was rechecked)
IV. Notes
The patient’s condition has been controlled through treatment, and I am happy for her. After surgery, we recommend a reasonable diet, high protein, low salt, low fat diet, do not eat too hot, too cold, spicy stimulating food, drink more water, eat more vegetables and fruits, crude fiber. Do your best to keep warm in daily life to prevent cold and flu caused by seasonal changes. Don’t cough hard to prevent the increase of cranial pressure, keep bowel movements smooth, and use laxative drugs if necessary. Control your emotions and avoid bad moods such as anger and depression. Under the guidance of the doctor, insist on taking oral antiepileptic drugs on time, avoid missing doses, avoid stopping drugs on your own, and have regular outpatient reviews.
V. Personal insight
Smoke syndrome is mostly seen in young people, with children and adolescents. It refers to abnormal development of cerebral blood vessels, forming a network of cerebral blood vessels like smoke, mostly with headache and other symptoms, associated with genetic factors, and headache is often the first symptom in adolescents, which should be considered when seizures occur. Seizures are controlled with antiepileptic drugs as soon as possible. Each occurrence of epilepsy is a trauma to the brain and should be treated symptomatically in a timely manner. In addition, with smog syndrome, angiography is the gold standard for diagnosis and early detection and treatment is more effective. Avoid coming to the hospital only when the patient’s symptoms are very severe or even induce epilepsy, as in this case.