Nurology notes.

Abstract.

In simpler terms, the text is describing a patient with epilepsy who had a sudden weakness on the left
side of their body. This weakness was caused by taking too much of a medication called phenytoin,
which interacted with another medication called clobazam.

They did a special type of brain scan (Magnetic Resonance Angiography) and found that one of the
blood vessels in the brain was narrowed. Other tests, like checking the rate at which red blood cells
settle in a test tube and analyzing the fluid around the brain, didn't show any problems. So, the doctors
thought the narrowed blood vessel was probably due to a condition called "benign angiopathy of the
central nervous system."

They also found that the patient had high levels of a substance related to blood clotting and a slightly
increased amount of another substance related to inflammation in their blood. This suggests that the
phenytoin overdose might have caused the blood vessels in the brain to squeeze too tightly, and this
might have led to some inflammation and blood clotting in those blood vessels.

So, in simple terms, the text is saying that too much phenytoin can make the blood vessels in the brain
narrow and cause some inflammation and blood clotting, which can result in weakness on one side of
the body in a person with epilepsy.

intro

Benign angiopathy of the central nervous system (BACNS) is indeed a rare cerebrovascular disorder with
clinical and angiographic features similar to those of cerebral angiitis. This condition is characterized by
severe headaches, vomiting, seizures, and focal neurological deficits. These symptoms can occur
following various associated conditions such as migraine, closed head injury, pregnancy, neurosurgical
procedures, and the intake of vasoactive drugs.

The underlying mechanism of BACNS is believed to be reversible cerebral arterial vasoconstriction.

Although there is rare laboratory and pathological evidence of significant inflammation in BACNS, the
exact cause and pathophysiology of the disorder are not completely understood.

In the case you describe, there is a patient who experienced sudden hemiparesis (weakness on one side
of the body) in association with phenytoin (PHT) intoxication. Phenytoin is an antiepileptic drug used to
treat seizures. The cranial magnetic resonance angiography (MRA) revealed focal vasospasm of the
branches of a middle cerebral artery. Vasospasm refers to the narrowing of blood vessels, which can
restrict blood flow to the affected area of the brain.

While transient hemiparesis has been reported in the context of phenytoin toxicity in the past, the
specific pathophysiological mechanism responsible for this effect has remained unknown. The report
suggests that this is the first documented case demonstrating reversible cerebral segmental
vasoconstriction as a potential complication of phenytoin intoxication.

It's important to note that phenytoin is a medication with a narrow therapeutic range, and its levels in
the bloodstream must be carefully monitored to avoid toxic effects. This case highlights the need for
further research and understanding of how phenytoin may lead to reversible cerebral vasoconstriction
in some individuals, especially in cases of intoxication.