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Musicogenic epilepsy is a rare form of reflex epilepsy in which seizures are provoked by music. Different musicogenic stimuli have been identified: pleasant/unpleasant music or specific musical patterns. Several etiologies have been uncovered, such as focal cortical dysplasia, autoimmune encephalitis, tumors, or unspecific gliosis. In this article, we report two patients with musicogenic seizures. The first patient was diagnosed with structural temporal lobe epilepsy. Her seizures were elicited by music that she liked. Interictal and ictal video-electroencephalography (video-EEG) and signal analysis using independent component analysis revealed the right temporal lobe seizure onset extending over the neocortical regions. The patient underwent right temporal lobectomy (including the amygdala, the head, and the body of the hippocampus) and faced an Engel IA outcome 3 years post-surgery. The second patient was diagnosed with autoimmune temporal lobe epilepsy (GAD-65 antibodies). Her seizures were triggered by contemporary hit radio songs without any personal emotional significance. Interictal and ictal video-electroencephalography (video-EEG) and independent component analysis highlighted the left temporal lobe seizure onset extending over the neocortical regions. Intravenous immunoglobulin therapy was initiated, and the patient became seizure-free at 1 year. In conclusion, musicogenic seizures may be elicited by various auditory stimuli, the presence or absence of an emotional component offering an additional clue for the underlying network pathophysiology. Furthermore, in such cases, the use of independent component analysis of the scalp EEG signals proves useful in revealing the location of the seizure generator, and our findings point toward the temporal lobe, both mesial and neocortical regions.

Objectives. Transient ischemic attacks (TIAs) can present with a large variety of clinical features that impose an extensive differential diagnosis. We report this case due to its particularities of clinical presentation and diagnosis algorithm. Material and methods. A 72-year old male patient presented to our Neurology Department for recurrent episodes of numbness felt in the right upper limb. The initial patient history deemed the episodes as consistent with simple focal seizures. The cerebral computed tomography scan showed no recent lesions. Furthermore, video-electroencephalography was performed, but revealed no abnormalities. A second, more thorough anamnesis revealed that paresthesia was also present in the left part of the upper and lower lips and that the numbness episodes were being accompanied by blurred vision, loss of balance and difficulties coordinating his right upper limb. results. The time-of-flight magnetic resonance angiography revealed dolichoectasia of the left vertebral and basilar arteries. Furthermore, the basilar artery grooved and displaced the pons with respect to the midline. The angio-computed tomography scan of the supra-aortic trunks showed multiple stenoses located in the V4 segment of both ver- tebral arteries, in the intracavernous segment of the right internal carotid artery and in the proximal segment (90%) and the middle third part (80%) of the basilar artery. The patient was diagnosed with vertebrobasilar TIAs and started treatment with Clopidogrel with no recurrence of the TIAs. Conclusions. This case was chosen to be presented in order to highlight another facet of the clinical polymorphism exhibited by transient ischemic attacks.

Objectives. The carotid-cavernous fi stula (CCF) represents an abnormal communication developed between the internal and/or the external carotid artery (ICA, ECA) or their branches and the cavernous sinus (CS). We report this case in order to highlight the course and an alternative to treatment of a CCF. Material and methods. A 47-year old male patient with medical history of subarachnoid hemorrhage and cranio-facial comminuted fractures due to a motorcycle accident-induced craniofacial traumatism (4 months prior to admission) was referred to our clinic for further investigation regarding a potential CCF. Results. The cerebral digital substraction angiography showed a direct CCF type A. The Neurology and Interventional Radiology team opted for endovascular stent-grafting of the right ICA. Conclusions. This case is presented in order to highlight that angioplasty with stent-graft is a safe and effectiveprocedure in selected cases of CCF.

Rationale: Systemic lupus erythematosus (SLE) is characterized by numerous immunological abnormalities that lead to multiorgan involvement. Central and peripheral nervous system manifestations are present in 8% to 92% of the cases of SLE. Furthermore, there have been reported cases of secondary autoimmune myelofibrosis associated with SLE. Patient concerns: We present the case of a 64-year-old female who was transferred from the Cardiology Department, where she was admitted for pericardial-pleural-peritoneal effusion after being discharged from another hospital following the resolution of a febrile episode. During hospitalization, she presented multiple oculomotor nerves palsies and weakness in the lower limbs. Serial cerebral magnetic resonance imaging (MRI) revealed extensive cerebral venous thrombosis. Nerve conduction studies showed sensory-motor axonal polyneuropathy. Thoracic MRI revealed a rare finding in patients with SLE – lytic lesions. Diagnoses: Extensive clinical, imaging, blood, and urine tests were performed. The patient exhibited pancytopenia, elevated inflammatory markers, hyperhomocysteinemia, mild hypoproteinemia, and severe proteinuria. The Hematology consultation ascertained that the peripheral blood smear and the bone marrow aspiration showed no alterations suggestive for a primary hematological disease and the thoracic vertebral-medullary MRI changes had a very low probability of representing osteolytic lesions in the context of plasma cells dyscrasia, but could not exclude their being result of a secondary autoimmune myelofibrosis. Immunology blood tests highlighted the presence of antinuclear antibodies and lupus anticoagulants. In this context, the Rheumatology consultation established the diagnosis of SLE with multiple complications. Interventions: The patient received treatment with cyclophosphamide. Outcomes: The ocular motricity problems and the paraparesis showed improvement. However, 1 week later, the patient developed weakness, dyspnea, and right lower quadrant abdominal pain. The abdominal-pelvic computed tomography scan indicated an acute right retroperitoneal hematoma with active bleeding for which she underwent arterial embolization of the spinal lumbar arteries with optimal result, but she died a few days later. Lessons: We chose to present this case in order to highlight the importance of interdisciplinarity in diagnosing and managing patients with SLE and multiorgan ailments, especially when faced with rare constellations of complications such as extensive cerebral venous thrombosis and osseous lytic lesions caused by secondary autoimmune myelofibrosis.