To report a case of iris non-Hodgkin lymphoma initially thought to be uveitis-glaucoma-hyphema (UGH) syndrome.We reviewed the clinical, radiographic, and histopathologic findings in a patient with recurrent hyphemas and increased ocular pressure who eventually was found to have a rapidly growing iris mass.An 89-year-old man with a history of cataract extraction and mantle cell lymphoma developed recurrent hyphema, which was subsequently revealed to be due to an iris mass. A biopsy revealed non-Hodgkin lymphoma that could not be formally subclassified but was suspicious for mantle cell lymphoma. The tumor showed a partial response to ibrutinib.Iris lymphoma can masquerade as a cause of recurrent hyphema after cataract extraction. Ophthalmologists should be aware of this presentation, especially in patients with a history of lymphoma.
OBJECTIVE: To determine the prevalence and characteristics of seizure clusters in a prospective study.
BACKGROUND: A seizure cluster is defined as the occurrence of multiple seizures within a short period of time. Clusters may negatively impact patient’s quality of life and often result in increased healthcare utilization.
DESIGN/METHODS Subjects were categorized according to their reported seizure frequency over the year prior to enrollment into one of the three groups: prior clusters, active epilepsy and seizure free. The prior clusters group included subjects reporting at least one day with two or more seizures. Subjects recorded duration, time, frequency, use of rescue medications, occurrence of injuries and emergency room visits and were contacted monthly for six months. For the primary outcome, we defined clusters as the occurrence of 2 or more seizures within 6 hours. Patients with daily seizures were excluded.
RESULTS: One hundred out of 300 (33.3[percnt]) patients reported clusters in the year prior to enrollment. Of those, 25 had prescribed rescue medication whereas 75 had not. Out of the 300 patients, 150 reached the six month milestone-52 were excluded due to noncompliance with their diaries, providing a sample size of 98. Of these 98 patients, 10 had single seizure-related injuries, 7 had single seizure-related ED visits, and 4 used rescue medication for a single seizure. Further, 29 out of 98 patients (29.6[percnt]) experienced seizure clusters -18 (62[percnt]) from the prior clusters group and 11 (38[percnt]) from the active epilepsy group. Of these 29 patients, 4 had cluster-related injuries, 5 had cluster-related ED visits and only 2 used rescue medication to abort a cluster.
CONCLUSIONS: Though seizure clusters and cluster-related injuries and ED visits are common, the use of rescue medications is not. Further analysis of prospective data will better identify risks and precipitants of seizure clusters.
Study Supported by: Upsher-Smith Disclosure: Dr. Choezom has nothing to disclose. Dr. Zhang has nothing to disclose. Dr. Zaveri has nothing to disclose. Dr. Radhakrishna has nothing to disclose. Dr. Gauthier has nothing to disclose. Dr. Joshi has nothing to disclose. Dr. Bonito has nothing to disclose. Dr. Hirsch has received personal compensation for activities with Lundbeck Research USA, Inc., Upsher-Smith, RSC Diagnostics, NeuroPace, Inc., and UCB Pharma as a consultant. Dr. Detyniecki has nothing to disclose.
Abstract As the field of neuro-oncology makes headway in uncovering the key oncogenic drivers in pediatric glioma, the role of precision diagnostics and therapies continues to rapidly evolve with important implications for the standard of care for clinical management of these patients. Four studies at major academic centers were published in the last year outlining the clinically integrated molecular profiling and targeting of pediatric brain tumors; all 4 demonstrated the feasibility and utility of incorporating sequencing into the care of children with brain tumors, in particular for children and young adults with glioma. Based on synthesis of the data from these studies and others, we provide consensus recommendations for the integration of precision diagnostics and therapeutics into the practice of pediatric neuro-oncology. Our primary consensus recommendation is that next-generation sequencing should be routinely included in the workup of most pediatric gliomas.
Objective: To report a case of hypothermia associated with clobazam in an adult epileptic patient.
Background: Benzodiazepines usually have only mild side effects, but they have been occasionally associated with hypothermia especially in the elderly or very young. Clobazam, a 1,5-benzodiazepine FDA approved in 2011, has never been associated with this adverse effect until very recently, in a case report involving two pediatric epileptic patients.
Methods: Case history was obtained through clinical record review.
Results: The patient is a 58-year-old male with a history of developmental delay, left hemiparesis, dysphagia, hypertension, cyclothymia, urinary retention, and a convulsive seizure disorder since he was 3 years old suggestive of Lennox-Gastaut syndrome. His seizures occur a few times per month, often in clusters. His medications include phenytoin (200 mg/day), levetiracetam (3000 mg/day), clonazepam (1 mg/day), fluoxetine (30 mg/day), quetiapine (100 mg/day), amlodipine (10 mg/day), and aspirin (81 mg/day). Clobazam was initiated at 5 mg/day and increased to 10 mg bid after a month. Seizures were initially controlled well. A couple months after starting clobazam, the patient began developing episodes of hypothermia every several weeks, with temperatures ranging from 90 °F - 95 °F. Normothermia was achieved with Bair Hugger therapy. TSH and cortisol levels were normal, and there was no evidence of infection in most instances. After 10 episodes of hypothermia, clobazam was tapered to 5 mg bid for a week because its benefit was unclear. The patient experienced 1 more episode of hypothermia during this time. Ever since clobazam was completely discontinued 7 months ago, there have been no more episodes of hypothermia.
Conclusions: This case report describes several episodes of hypothermia associated with clobazam use in an adult patient, which stopped after the drug was discontinued. Future studies of hypothermia with correlated drug levels are warranted to further explore this association. Disclosure: Dr. Gauthier has nothing to disclose. Dr. Quraishi has nothing to disclose. Dr. Mattson has nothing to disclose.
