무균성 뇌수막염 후 실조성 편측부전마비를 동반한 홍소발작 1례

Gelastic Seizure with Ataxic Hemiparesis Following Aseptic Meningitis

저자들은 무균성 뇌수막염 후, 뇌 자기공명영상에서 우측 시상에 병변이 관찰되면서 임상적으로 특징적인 홍소발작과 실조성 편측부전마비를 동반한 5세 남자 환아에서 항경련제와 스테로이드 치료 후 증상이 호전된 례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

Gelastic seizure(ictal laughter) is quite rare and associated with variable etiologies. The relationship between infection and gelastic seizure is not clear. The seizure usually begins in infancy or childhood and may be accompanied with precocious puberty and cognitive decline. It is known to be poorly responded to medical or surgical treatments. A 5-year-old boy diagnosed and aseptic meningitis visited our hospital again twenty days later because of paroxysmal and frequent involuntary laughing regardless of emotional changes, left side dominant muscle weakness and ataxia with gait disturbance for 5 days. Initial brain magnetic resonance image(MRI) showed no abnormalities but follow-up MRI taken twenty days later showed high signal intensity on right thalamus. The interictal electroencephalogram(EEG) revealed multiple polyspikes over the frontal area. Other etiologies could not be documented. It was suspected that previous aseptic meningitis resulted in gelastic seizure with ataxic hemiparesis. After medical treatment, he acquired good outcomes with a seizure free state.