Unconscious with convulsions

[gotincoma]

4 weeks ago I fell unconscious for something between 35 and 45 minutes. For the first 3 minutes I had convulsions.

I had MRI on my brain as well as EEG.

Here is the MRI report

==== Beginning of the Report
Technique
- axial T1 and T2 weighted Images
- Coronal FLAIR and Sagittal T2 weighted images.

Findings:
= Multiple small variable sized focal cerebal areas of abnormal signal intensity are seen at both parietal suc-cortical and peri-ventricular regions. high occipital, high frontal regions/
= they appear of high FLAIR and T2 signal and exerting no mass effect. They are not distinguished on T1 weighted images.
= Normal size and configuration of the venticular system with no midline shift.
= Normal appearance of cortical sulci with no extra-axial collections.
= Normal MRI appearance of the brain stem and cerebellum with intact cervico-medullary junction/

Conclusion:
Mutiple small (variable sized) bilateral deep cerebral focal areas of abnormal signal intensity (as above described) likely representing ischemic foci (?due to some sort of vasculitis), rather than demyelinating process, for clinical corrlation.

===== end of MRI report

The EEG showed some alpha waves and some extra electricity.
Both the MRI and EEG were done in less than 24 hours of me getting unconscious.

Blood picture is OK and no auto-immunity markers found. Also the ESR is 25.

Background information

a 34 years old male working very long hours on computers and fell under prolonged job stress. little and irregular sleep pattern and not very good eating habits. On that day I had 3 hours of sleep and not food for long hours before falling unconscious.

do I have MS or ADEM or TIA?

What does this vasculitis do?

I plan to do a follow up MRI in two weeks. What should I expect???

[Quixotic1]

I can't really help you here.  Those theories of why a seizure disorder develops don't really mesh with what I understand.  But it's not my field of expertise at all.  In my experience the meds are continued as long as the EEG remains abnormal. Sometimes that's a short time - a year or so, or sometimes it's lifelong.  I wish you the best of luck, Quix

[gotincoma]

In theory 1 above, I meant partial seizures

[gotincoma]

Hello Quix,

Thanks once again.

I forgot to mention that my doctors gave me a Cortisone pulse (1gm per day for three days at a controlled rate in a 250 cm saline for 2 hours.

From what you say and whay I understood from the doctors it seems like there are three theories and please correct me if I'm wrong.

Theory 1: I was stressed for a long time and this was going to get me into seizure and even a stroke sooner or later. This caused all these confusion periods (mono-seizures) and causred these areas of vessel inflammations in my MRI. The solution is fundamentally a change in life style in addition to the cortisone pulse I had and some medication to control brain electricity for a while until I come back to normal. The proof will be when the next MRI shows that the inflammations are getting much smaller or even go away completely because of the cortisone pulse I had.

Theory 2: Some people have readiness of epiliptic attacks that don't show up under normal stress conditions. Now I had a prolonged stress that exceeded the limits and it showed up first in the confusions and then later in the loss of conscious. The treatment is anti-epiliptic medication for a longer while (same as theory 1) and of course a change in life style.
Proof will come in the next MRI when the inflammations persist and the EEG still shows irregular waves.

Theory 3: I have some slow demylination process like ADEM. This theory does not interpret the confusins though because ADEM is a result of a virus.
If this theory is correct then next MRI will show a persistent inflammation pattern.

Do I get it right?

I tend to believe theory 1 but in that case, I don't know for how long do I need to take this anti-epiliptic medication???

[Quixotic1]

Stress itself doesn't cause epilepsy, but the problems stress can cause (like sleep deprivation) certainly can cause someone with a seizure-prone brain to have a seizure.  Epilepsy can show up at any age.  When it does, no matter how old someone is, you first want to exclude serious problems like tumors, infection, vasculitis, etc.  Your doctors seem to be following you closely.  That is good.  Yes, those periods where you felt weird, confused and couldn't do anything, may have been something called partial seizures.  Sometimes partial seizures become more complicated and actually turn into full-blown siezures.

Good luck, Quix

[gotincoma]

Hello Quix,

Thanks for the comment.

Well, I don't have a history of migraines. I never had one. My blood pressure is low normal at 110/70 and was measured to be 110/70 once I was reushed into the emergency room.

Currently, my Doctor is giving me anti-epiliptic medications and other stuff with high dose of B-12.

during the past year, I had an intense and stressfull period. Occasionally (like once every 3-4 months), I had short periods of confusion. I can hear and understand speech but I can't really respond. It lasts like 30 seconds or one minute. It happened to me the same day I lost conscious.

Could that be epilypsy that showed up because of prolonged stress? We have no family history of epilypsy though and I thought it shows up in childhood....

I should have a second MRI next week... what should I expect?

Thanks a lot

gotincoma

[Quixotic1]

You describe a classic seizure (convulsion) with a normal post-seizure period of unconsciousness.  It sounds from your description that your brain-wave tracing, the EEG, showed abnormal activity.  Is this correct?

Your MRI indicates some areas of inflammation which the radiologist thought looked more like vascular damage then specific nerve damage.  Do you have a history of migraine headaches?  of high blood pressure?

Your ESR is only mildly high for a man of your age.  something as simple as a minor infection could cause this.  

I don't think anyone could make any of those diagnoses from what you have told us.  Your doctors need more information and that is why they have scheduled another MRI.  

Good luck, Quix