Skip to main content Accessibility help
×
Home
  • Print publication year: 2011
  • Online publication date: May 2011

Case 93 - Nonconvulsivestatus epilepticus

from Section II - Neurocritical care

Summary

Encephalopathies are commonly encountered in the intensive care unit (ICU) and portend worse outcomes. This chapter presents a case study of a 54-year-old man with a history of alcohol abuse and cirrhosis who was admitted to the neurologic ICU after drainage of a large right-sided subdural hematoma. His mental status returned to baseline after treatment with lactulose and neomycin. A general physical examination should search for evidence of trauma or intoxication. Meningismus should be evaluated. A fundoscopic examination may reveal papilledema. Electroencephalographic monitoring during administration of flumazenil can be used to determine if an occasional subclinical seizure can be detected. Inflammatory mediators have also been implicated in the etiology of hepatic encephalopathy. Ruling out physiologic, pharmacologic, and neurologic etiologies requires a thorough history, careful physical examination, and the appropriate use of laboratory and imaging tests. Treatment should be tailored to the underlying etiology of the encephalopathy.

References

1. M. Ghofrani, F. Mahvelati, H. Tonekaboni et al. Headache as a sole manifestation in nonconvulsive status epilepticus. J Child Neurol 2007 May; 22: 660–2.
2. A. R. Towne, E. J. Waterhouse, J. G. Boggs et al. Prevalence of nonconvulsive status epilepticus in comatose patients. Neurology 2000; 54: 340–5.
3. S. K. Velioğlu, S. Gazioğlu. Non-convulsive status epilepticus secondary to valproic acid-induced hyperammonemic encephalopathy. Acta Neurol Scand 2007; 116: 128–32.
4. S. Rupprecht, K. Franke, S. Fitzek et al. Levetiracetam as a treatment option in non-convulsive status epilepticus. Epilepsy Res 2007; 73: 238–44.
5. D. J. Borris, E. H. Bertram, J. Kapur. Ketamine controls prolonged status epilepticus. Epilepsy Res 2000; 42: 117–22.