# Aphasic Status Epilepticus Treated in the Emergency Room: A Report of Two Cases

## TL;DR

Two cases of aphasic status epilepticus were treated in the emergency room, showing that it can mimic stroke and requires prompt treatment.

## Contribution

The paper presents two clinical cases of aphasic status epilepticus and recommends immediate treatment with benzodiazepine.

## Key findings

- ASE can mimic stroke and may cause lasting effects if treatment is delayed.
- Immediate treatment with benzodiazepine is recommended when stroke is ruled out.
- EEG and SPECT findings helped confirm the diagnosis in both cases.

## Abstract

The clinical characteristics of patients with an aphasic status epilepticus (ASE) remain unclear. Here, we present two cases with ASE. Case 1 was a 61-year-old man who was admitted to our hospital with cortical deafness and severe aphasia. He was treated in our emergency department for status epilepticus, and his symptoms resolved. Electroencephalography (EEG) showed lateralized periodic discharges in the left temporo-parietal lobes. Single-photon emission computed tomography (SPECT) showed a high-uptake lesion in the left temporo-parietal lobes. Case 2 was an 80-year-old woman who was admitted to our hospital with tonic-clonic seizures. Even after she became alert, she continued to have severe aphasia. EEG showed generalized spike-and-slow wave complexes. She was treated for status epilepticus, and her symptoms resolved. SPECT after her aphasia resolved showed high-uptake lesions in both parietal lobes. At the time of her recurrence 2.5 years later, she was treated in our emergency department for status epilepticus, and her symptoms immediately resolved. Both cases were diagnosed with aphasic status epilepticus. ASE should be considered as a stroke mimic and may cause sequelae due to delayed treatment. We recommend that patients suspected of ASE should be treated immediately with benzodiazepine without waiting for electroencephalography or perfusion imaging when ischemic stroke is ruled out by MRI, including diffusion-weighted imaging (DWI).