Quiz Form

Question Date: 02/12/2023

Question: After 3 days of a febrile illness, a previously well 19 years old developed focal seizures with loss of awareness. The seizures progressed to generalised tonic-clonic seizures and convulsive status epilepticus requiring sedation and ventilation in intensive care. cEEG during in ICU shown below. What would be the likely diagnosis?

Options:

• Brain abscess
• Cerebral venous sinus thrombosis
• HSV encephalits
• NORSE

Correct Answer: NORSE

View Image: Image_202311160811156555cea3f0200.png

Explaination: While earlier literature generally used NORSE for adult patients and FIRES for children, working definitions do not make this distinction, and both terms now apply in all ages<br><br>Three common early patterns<br>- initially infrequent seizures gradually evolving into status epilepticus<br>- beta-delta complex resembling delta brushes<br>- characteristic seizure onset pattern with focal fast activity with shifting seizures<br><br>Other patterns reported in Adults periodic discharges (generalised, lateralised, bilateral independent and multifocal) and multiple seizure patterns (generalised, focal and multifocal)

Reference: Mantoan RitterL,NashefL. New-onset refractory status epilepticus (NORSE)Practical Neurology2021