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Paroxysmal Staring and Masticatory Automatisms During Postural Hypotension in a Patient with Multiple System Atrophy
Author(s) -
Iani Cesare,
Attanasio Antonio,
Manfredi Mario
Publication year - 1996
Publication title -
epilepsia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.687
H-Index - 191
eISSN - 1528-1167
pISSN - 0013-9580
DOI - 10.1111/j.1528-1157.1996.tb00635.x
Subject(s) - atrophy , medicine , anesthesia , cardiology , pure autonomic failure , blood pressure , masticatory force , heart rate , electroencephalography , epilepsy , orthostatic vital signs , orthodontics , psychiatry
Summary:Purpose: We studied a 51‐year‐old man with multiple system atrophy and autonomic insufficiency. He had repeated episodes of loss of contact, staring, and masticatory automatisms. Methods: Blood pressure during these events documented a systolic pressure of 60 mm Hg. Cardiovascular reflex tests provided evidence of autonomic failure. Head computed tomography (CT) revealed moderate, diffuse cortical and cerebellar atrophy. Results: These events were strictly related to blood pressure decreases and could be reproduced consistently by having the patient sit up after a meal. Ictal polygraphic recordings showed EEG changes consistent with anoxia, preceded by sudden hypotension with fixed heart rate. Conclusions: Cerebral anoxia during a syncopal attack may therefore precipitate transient, sudden neurologic dysfunction that closely mimics complex partial seizures. Masticatory automatisms may represent a release phenomenon resulting from inactivation of neocortical structures by cerebral anoxia or reticular disconnection.