Status epilepticus.ppt

Status epilepticus Presented by R2康庭瑞 Case 63 year-old man HTN with nephritic syndrome; DM with triopathy Fell down upon his occipital area on Aug 15, lost of consciousness for 2 minutes with massive scalp bleeding He was sent to ER with clear consciousness. Head CT revealed no ICH Case Seizure occurred (GTC pattern) for 1~2 mintues on Aug 16 am. Lost of consciousness about 7~8 hours was noted? uremic encephalopathy was impressed and emergent H/D was done Frequent seizure was noted on Aug 16 pm and Aug 17 with unconsciousness, GCS E1M2V1 Repeated head CT on Aug 17 showed no ICH or other active lesions Case EEG revealed moderate diffuse cortical dysfunction on Aug 18 Low grade fever? CNS infection was suspected? CSF study showed no abnormalities Phenytoin 100mg T.I.D, Lamictal, Deparkine 600mg B.I.D?seizure activity persistent and he was transferred to ICU for aggressive management and EEG monitoring Case He was intubated on Aug 25 and IV Dormicum was prescribed and dosage was step-up(36mg/hr) due to frequent seizure; Propofol(60mg/hr) was added on Aug 27 due to uncontrolled seizure? S/S persistent Status epilepticus, R/O uremic encephalopathy and infection related Asked for gas anesthesia for suppressing seizure activity on Aug 31 Case Seizure pattern：contraction over distal part of limbs, mandible and bilateral eyelids; Duration– 5~10 minutes, interval– 10~20 minutes; EEG at bedside– diffuse sloe wave Desflurane inhalation (0.5 MAC) and decreasing the percentage of desflurane concentration gradually, smoothly without observable seizure activity After 4 hours of gas inhalation, the patient was transferred back to ICU. EEG monitor showed burst suppression Definition Status epilepticus is defined as continuous convulsions, or intermittent convulsions without incomplete recovery of consciousness Seizure persists an estimate of duration that necessary to cause injury to central nervous system Refractory status epilepticus (RSE) has been defined as continuous seizur