Unusual Set of Adverse Effects During Right-Unilateral Ultrabrief Electroconvulsive Therapy Led to the Discovery of a Brain Tumor: A Case Report
Language English Country United States Media print
Document type Case Reports, Journal Article
PubMed
31348114
DOI
10.1097/yct.0000000000000618
PII: 00124509-202003000-00014
Knihovny.cz E-resources
- MeSH
- Depressive Disorder, Major therapy MeSH
- Diagnostic Imaging MeSH
- Adult MeSH
- Electroencephalography MeSH
- Electroconvulsive Therapy adverse effects MeSH
- Humans MeSH
- Brain Neoplasms diagnosis MeSH
- Incidental Findings MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Case Reports MeSH
We describe a case of a right-handed, 42-year-old, Caucasian female patient who manifested a set of unusual adverse effects during maintenance ultrabrief right-unilateral electroconvulsive therapy (ECT)-generalized myoclonic secondary seizure with lateralization nonresponsive to repeated intravenous diazepam application, deviation of the tongue and the head to the left, ping-pong gaze with nystagmoid jerks, postictal hypoactive confusion state lasting 15 minutes (with a total time to recovery 30 minutes), and likely Todd's paralysis after the procedure (subsided within 24 hours). These adverse effects led to a thorough clinical investigation and eventually the discovery of a brain tumor. In the article, we hypothesize about the possible interaction between the intracranial mass and ECT and provide a literature overview on the topic. Cases like this are likely underreported, and although several studies demonstrate that ECT can be applied safely to patients with an intracranial mass, this report demonstrates that brain tumor can interfere with ECT in an unpredictable way and have severe consequences (eg, unresponsiveness to diazepam when attempting to halt the seizure as our patient). Unusual symptoms after ECT, albeit reversible, such as in this case report, should be followed by a thorough neurological check-up to exclude any underlying organic pathology.
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