Recovery after severe refractory status epilepticus and 4 months of coma
| Autor: | Lawrence J. Hirsch, Rebecca Bausell, Alexandra Svoronos, Laura Lennihan |
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| Rok vydání: | 2011 |
| Předmět: | |
| Zdroj: | Neurology. 77:1494-1495 |
| ISSN: | 1526-632X 0028-3878 |
| Popis: | New-onset refractory status epilepticus (NORSE) describes a prolonged seizure state of unknown etiology that occurs in a person without prior seizures.1 The prognosis in the literature is poor.1,–,4 We present a patient with NORSE who recovered after 4 months of coma. ### Case report. A healthy 29-year-old man with no epilepsy risk factors experienced 2 weeks of upper respiratory symptoms followed by lethargy. On admission to a regional hospital he was stuporous, febrile, and vomiting. The following day, he experienced multiple generalized convulsions requiring intubation. Ten days later, he was transferred to Columbia on continuous IV propofol and midazolam, as well as levetiracetam, phenytoin, and phenobarbital. Continuous EEG (cEEG) showed electrographic status epilepticus (figure e-1 on the Neurology ® Web site at www.neurology.org). Upon admission, he was comatose, with absent cranial nerve reflexes except for sluggishly reactive pupils. All autoimmune, paraneoplastic, and infectious laboratory studies were negative except for antinuclear antibody. Brain biopsy showed nonspecific inflammation; however, the etiology was never identified. See table e-1 for diagnostic tests and figure e-2 for select MRIs. His seizures were highly refractory, requiring high doses of IV midazolam, pentobarbital, and ketamine; treatments administered are listed in table e-2. He … |
| Databáze: | OpenAIRE |
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