Friday, July 11, 2008

Insulinoma mimicking seizure

Bazil CW, Pack A Insulinoma presenting as a seizure disorder. Neurology 2001; 56:817-818.

This rare disease mimicking a common disease needs to be added to the knowledge of doctors diagnosing individuals with various "spells." A 45 year old woman had troubel with panic attacks, inability to focus, tongue/limb tingling, perception of yellow spots and cold sweat. She later developed episodic unresponsiveness and jerking. Waxing and waning irda and polymorphic delta was seen on eeg, without interictal discharges, and the patient was felt to have pseudoseizures. A low glucose of 55 was found, islet cell tumors of the pancrease were found and removed and the patient took diazoxide with improvement.

Insulinoma usually includes nonspecific symptoms such as dizziness, apathy, headache and confusion. It is rare. affecting at most 5 per million.

Neuropsychiatric Profiles of Patients with Insulinomas; Ding Y, Wang S, Liu J, Yang Y, Liu Z, Li J, Zhang B, Chen Y, Ding M; European Neurology 63 (1), 48-51 (Dec 2009)
A review of 42 patients with insulinoma was undertaken, showing that many went undiagnosed for up to five years with neurologic and neuropsychiatric symptoms. 12 were misdiagnosed as epilepsy with eeg findings. Others received psychiatric diagnoses. Clinical presentation was usually confusion, convulsions and visual disturbance.

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