Beatriz Epitacio Neri

Objective: Neuropsychiatric interictal comorbidities (NPC) may increase the risk of epilepsy. Peri‐Ictal Neuropsychiatric manifestations (PI‐NPM) occur in 20–40% of people with epilepsy (PWE). Clinical phenomena and outcomes are poorly understood in PWE with NPC and/or PI‐NPM. Our study sought to describe NPC and PI‐NPM clinical features and identify their association to breakthrough seizures (BSz) in a Third‐Level Specialized Neurological Center Emergency Department (ED). Methods: A retrospective cohort including adult patients with diagnosis of epilepsy seen in the ED was analyzed. Demographic characteristics were performed using chi‐square and t ‐tests. PWE were divided into those with only one admission with BSz, and those that were readmitted to ED with BSz (2BSz) during a 1‐year period. A logistic regression analysis was designed including significant variables of the association analysis and age and time of diagnosis as covariates to look for neuropsychiatric predictors of readmission due seizure relapse. Results: Two hundred‐sixty‐four participants were included. 133 patients (50%) were male, and 111 cases (42%) of PWE with readmission (2BSz). The presence of NPC was associated with re‐admission (2BSZ) ( X ² 6.730, p = 0.009). No significant associations were found considering the PI‐NPM. Anxiety was the most prevalent pre‐ictal neuropsychiatric symptom (14.4%) and post‐ictal symptom (33.7%). No significant differences were observed in logistic regression considering PI‐NPM compared to those without PI‐NPM manifestations for readmission. The presence of NPC demonstrated a 1.88 OR for readmission in one year‐period compared to those PWE without NPC Significance: PWE with NPC have an increased risk of readmission to ED due seizure relapse. Anxiety is the most frequent pre‐ictal and post‐ictal manifestation. However, the presence of PI‐NPM did not exhibit any association for readmission due seizure relapse.

La coccidioidomicosis afecta primordialmente al tejido pulmonar. Cursa de forma asintomática en el 50% de los casos, pero el 1% se manifiesta con diseminación hacia otros órganos, siendo la afectación cardiaca extremadamente rara. Describimos el caso de un paciente diagnosticado con coccidioidomicosis meníngea con diseminación a las cavidades cardiacas cursando como Endocarditis Infecciosa por la presencia de un fungoma.