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This chapter discusses the diagnosis, evaluation and management of status epilepticus. Seizures, which may be the result of central nervous system (CNS) infection, require early and empiric antibiotics, antivirals, and possibly steroids, ideally before lumbar puncture is performed. Seizures may require additional treatment and can be refractory to first-line agents (i.e., benzodiazepines) and second-line agents (i.e., phenytoin, phenobarbital, and valproate). If seizures are refractory to first- and second-line agents, levetiracetam or lacosamide, or induction with general anesthesia by inhalational anesthetics has to be considered. The most likely causes for sudden decompensation are airway compromise/respiratory failure, sepsis/septic shock, and recurrent seizure activity. Patients requiring multiple boluses of medications or continuous infusions should be considered for intubation for airway protection. Patients with an infectious etiology may rapidly progress to sepsis and require additional hemodynamic support. Prolonged seizure activity with or without overt muscle twitching is associated with increased mortality.
This chapter discusses the diagnosis, evaluation and management of acute spinal cord compression. It presents special circumstances which make diagnosis and management of Cauda equina syndrome difficult. Spinal shock is characterized by a loss of spinal cord function below the level of the lesion. Cervical and thoracic level lesions may be associated with respiratory compromise. The spinal shock results in a disruption of sympathetic innervation causing unopposed parasympathetic tone, which may also cause hypotension and bradyarrhythmias (neurogenic shock). The spinal shock is characterized by flaccid paralysis and loss of bladder/bowel control. The diagnosis of acute spinal cord compression is suggested by history and physical examination, and confirmed by radiography or surgical intervention. Clinical presentations may vary depending on the level of neurological injury. The most likely causes for sudden decompensation in spinal cord include expansion of the ending lesion causing worsening neurological compromise or a high cervical/thoracic lesion.