A 73-Year-Old Woman with Respiratory Failure and Stimulus-Induced Rhythmic, Periodic, or Ictal Discharges (SIRPIDs) in the Absence of a Detectable Brain Insult Diagnosed and Monitored by Continuous Electroencephalogram (EEG) and Treated with Valproate, Carbamazepine, and Clonazepam
| Autor: | Raid M. Kofahi, Majdi Al Qawasmeh, Kefah Al-Hayk, Khalid El-Salem, Salma Y. Bashayreh, Abdel-Hameed Al-Mistarehi, Adel Bataineh, Ahmed Yassin |
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| Rok vydání: | 2021 |
| Předmět: |
Critical Care
Critical Illness SIRPIDs Neurological examination Case Reports Video-EEG 030204 cardiovascular system & hematology Electroencephalography Continuous EEG Clonazepam Benzodiazepines 03 medical and health sciences 0302 clinical medicine Humans Medicine Ictal Aged Coma medicine.diagnostic_test business.industry Valproic Acid Brain Articles General Medicine Carbamazepine Patient Discharge Respiratory failure 030220 oncology & carcinogenesis Anesthesia Midazolam Female medicine.symptom Respiratory Insufficiency business medicine.drug |
| Zdroj: | The American Journal of Case Reports |
| ISSN: | 1941-5923 |
| Popis: | Patient: Female, 73-year-old Final Diagnosis: SIRPIDs Symptoms: Stimulus-induced jerks in the head and right arm • right gaze deviation Medication: Valproate • Carbamazepine • Clonazepam Clinical Procedure: Continuous video-electroencephalogram Specialty: Neurology Objective: Rare phenomenon Background: Stimulus-induced rhythmic, periodic, or ictal discharges (SIRPIDs) commonly occur in critically ill patients and can be distinguished from spontaneous epileptic seizures by continuous electroencephalogram (CEEG) monitoring. There are no current treatment guidelines for SIRPIDs. This report is of a 73-year-old woman with respiratory failure and without any detectable gross brain lesions. She had developed SIRPIDs, which were diagnosed through CEEG monitoring. She responded well to valproate, carbamazepine, and clonazepam. Case Report: A 73-year-old woman was admitted to the intensive care unit (ICU) with a chest infection. After 3 days, this infection was complicated by respiratory failure and coma, for which she was intubated. After that, recurrent brief episodes of abnormal head and right upper limb jerky movements with right gaze deviation occurred. Nurses noticed that these episodes occurred exclusively upon physical interaction with the patient, and lasted up to 3 minutes. No focal findings were noted on neurological examination. The brain computed tomography (CT) scan revealed no acute brain insult. CEEG revealed SIRPIDs, which abated with midazolam boluses, followed by infusion at 15 mg/hour. Later, they were controlled by valproate, carbamazepine, and clonazepam in succession, guided by CEEG data. Conclusions: This report shows the importance of CEEG monitoring to diagnose SIRPIDs and monitor treatment response. It also suggests that SIRPIDs can occur even in the absence of gross brain pathology. Although there are no current treatment guidelines for SIRPIDs, the use of valproate, carbamazepine, and clonazepam can help control them, as evidenced in this case. |
| Databáze: | OpenAIRE |
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