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ABSTRACT Introduction: Nonconvulsive status epilepticus NCSE ; presents heterogeneous clinical and electrographic characteristics, being probably underdiagnosed and often treated in an inadequate manner. Clinically, NCSE is mainly characterized by states of altered consciousness and or behavior of variable intensity exceeding 30 minutes. Subtle motor manifestations can also be observed, such as fascial fasciculations, discrete myoclonus, limb tremors, manual and oroalimentary automatisms, nystagmus, and head deviation. The electrographic findings are also varied, with epileptic discharges occurring continuous or almost continuously. Objectives: To characterize clinical and electroencephalographic features of non-convulsive status epilepticus. Discussion: Non-convulsive status epilepticus can be classified into generalized NCSE typical and atypical absence SE ; and focal NCSE complex partial and simple partial SE ; . The condition encompasses different clinical types and etiologies. In this paper we propose that signs and symptoms of varied etiology, evolution and prognosis be considered separately and analyzed under the denomination of "NCSE in special conditions". Conclusions: The clinical and electrographic spectra of NCSE are wide. Long-term prospective studies are still needed to establish epidemiological data and prognostic factors regarding Brazilian patients. Although many studies addressing treatment of these patients are available, several points still continue to be controversial. SE under specific circumstances probably needs to be dealt separately. Key words: nonconvulsive status epilepticus, complex partial status, absence status, focal nonconvulsive status. RESUMO Estado de mal epilptico no-convulsivo: aspectos clnicos e eletrogrficos Introduo: Estado de mal epilptico no-convulsivo EMENC ; apresenta caractersticas clnicas e eletrogrficas heterogneas, sendo provavelmente subdiagnosticado e muitas vezes tratado de forma inadequada. Clinicamente, se caracteriza por quadros de alterao da conscincia e ou do comportamento, com intensidade varivel e durao superior a 30 minutos, podendo ser observadas manifestaes motoras sutis como fasciculaes faciais, mioclonias discretas, tremores em membros, automatismos manuais e ou oroalimentares, nistagmo e desvio do segmento ceflico. Eletrograficamente os achados tambm so variados, podendo as descargas ser contnuas ou quase contnuas. Objetivos: Caracterizar os estados de mal no convulsivos do ponto de vista clnico e eletrogrfico. Discusso: O estado de mal no-convulsivo pode ser subdividido em uma forma generalizada EMENC de ausncia tpica e atpica ; e outra focal EMENC parcial complexo e parcial simples ; . Esta condio envolve mltiplos tipos clnicos e eletrogrficos, alm de diversos tipos de etiologias. Neste artigo propomos que quadros com etiologia, evoluo e prognstico variados sejam considerados separadamente, e analisados sob a denominao "EMENC em condies especiais". Concluses: Os espectros clinico e eletrogrfico do EMENC so amplos. Estudos prospectivos, de longo.

In summary, this report is a rare case of disseminated, poorly differentiated cardiac sarcoma, where thallium tumor imaging played an important role. Thallium imaging was introduced in the early 1970s. At least one comment in the literature suggested it might be good for tumor imaging.2 In 1976 the first incidental tumor was detected using thallium imaging, which confirmed the original belief.3 As part of our reason to choose thallium, some reports have discussed cerebral metastases similar to this case. The lesion presented by this patient could be used as a control.4, 5 It is the experience of the authors that most insurance companies will cover thallium tumor imaging. PET is the first study of choice for most tumor imaging, including sarcoma evaluation. However, in this case an application to the Centers for Medicare and Medicaid Services for soft-tissue sarcoma approval was denied on the basis of lack of evidence. Preauthorization is obtained for all PET requests. In this case, the insurance company would not cover indications beyond the approved list of the Centers for Medicare and Medicaid Services. CT and MRI have yet to offer on a large scale whole body imaging, which is the strongest point of nuclear medicine. Sometimes unsuspected primaries or metastases are identified.6-8 For example, a gallium tumor scan showed a single sacral metastasis that changed an operable carcinoma into an inoperable carcinoma unpublished ; , for a patient with lung carcinoma. Other cases have detected the unknown primary tumor from a bone scan in renal soft tissue that was unsuspected.

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