Abstract Details

Title Cefalexin-Induced Electroencephalography Changes Mimicking Creutzfeldt-Jakob disease

Topic Epilepsy/Clinical Neurophysiology (EEG)

Presentation(s) P16 - Poster Session 16 (8:00 AM-9:00 AM)

Poster/Presentation
Number 10-007

Objective We present a case of cefalexin associated electroencephalographic changes mimicking Creutzfeldt- Jakob disease in an elderly patient with subacute cognitive and gait decline with neuropsychiatric symptoms.

Background Several antibiotics are known to cause electroencephalographic (EEG) changes that can mimic Creutzfeldt- Jakob disease (CKD). Awareness of the effects of commonly prescribed drugs on EEG recordings are important in clinical practice.

Design/Methods NA

Results We describe the case of an 82 year old lady admitted under the geriatric service at our institution primarily for pain control secondary to multilevel lumbar spine fractures and falls. She had a background of diabetes, IHD and hypertension. A neurological opinion was sought amid a subacute cognitive decline, confusion. Her neurological exam including cranial nerves and limb examination was normal. She had no frontal release signs. She uses a rollator to mobilize for antalgic gait. Investigations including routine bloods and cerebrospinal fluid analysis were normal. Her MRI brain showed mild global atrophy with microvascular disease. During her inpatient course she developed sepsis several times, became increasingly confused and received multiple antibiotics for urinary tract and chest infections. Her initial EEG was globally abnormal with theta and delta showing and occasional triphasic waves. Repeat EEG showed progression of these changes with generalized periodic triphasic complexes. A second CSF analysis was tested for RT-QuIC and was negative. Further neurological exams revealed no clinical signs to indicate prion disease, the absence of which prompted a pharmacological review. There have been rare reports of cephalosporins causing encephalopathy and similar EEG changes. A further EEG one month later showed ongoing global slowing without any triphasic waves. The patient gradually improved to her baseline.

Conclusions Cephalosporins are prescribed commonly in clinical practice and may be associated with encephalopathy and EEG changes that mimic other disorders. This can have serious implications for the patient and the treating team.

Authors/Disclosures
Siobhan Delaney, MD (St James's Hospital) PRESENTER	Dr. Delaney has nothing to disclose.
	No disclosure on file
Jennifer M. Dineen, MD (The Beacon Hospital)	No disclosure on file
Brian McNamara, MD (Cork University Hospital)	Dr. McNamara has nothing to disclose.
Orna O'Toole, MB, BCh, BAO MD (Mercy University Hospital)	Dr. O'Toole has nothing to disclose.

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