Nonconvulsive status epilepticus associated with periodic lateralized epileptiform discharges in a patient with syphilis

Nonconvulsive status epilepticus (NCSE) has been increasingly recognized as a cause of impaired level of consciousness in the ICU and emergency rooms. The confirmation of NCSE is largely based on the EEG, given the nonspecific and pleomorphic clinical manifestations. Debate remains over electroencephalograms (EEG) criteria for NCSE. Periodic lateralized epileptiform discharges (PLEDs), have sparked controversy with regard to being part of the ictal vs. interictal spectrum. We report a case of a patient with syphilis who had cognitive decline and damaged consciousness with PLEDs and T2 hyperintensity at temporal and occipital lobe in MRI. After antiepileptic treatment only, his consciousness improved markedly together with the EEG in few days, while the change of MRI was still serious. In this case PLEDs is the sign of NCSE and change of MRI is limbic encephalitis (LE). This report discusses the association of PLEDs and NCSE, and supports the concept of PLEDs as an ictal pattern in some condition