Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Feb 19 2022

Status Epilepticus

Images seizure.jpg
  • Snapshot
    • A 79-year-old man presents to the emergency department after a fall complicated by a head strike. He underwent a non-contrast CT head, which demonstrate bilateral subdural hematoma without evidence of cerebral herniation. Neurosurgery was consulted and determined the intracranial bleeds were small and his neurological exam was unremarkable. He was also found to have a complicated urinary tract infection, requiring hospital admission for treatment with intravenous antibiotics. On hospital day 3, the patient has a generalized tonic-clonic seizure that lasted 6 minutes. He is started on intravenous lorazepam and is loaded with levetiracetam. His seizures eventually clinically abort and he is placed on electroencephalography.
  • Introduction
    • Definition
      • seizures that lasts ≥ 5 minutes OR
      • incomplete recovery of consciousness between ≥ 2 discrete seizures
  • Etiology
    • Structural abnormalities
      • stroke (most common in older adults)
      • brain malignancy
      • intracranial bleed
      • head trauma
      • arteriovenous malformations
    • Infections
      • meningitis
      • encephalitis
    • Metabolic abnormalities
      • hypo- or hyperglycemia
      • hepatic encephalopathy
      • hypo- or hypernatremia
      • hypocalcemia and hypomagnesemia
      • uremia
      • sepsis
    • Medications/toxins
      • antiepileptic drug nonadherence
      • alcohol, benzodiazepine, or barbiturate withdrawal
      • other medications that lower the seizure threshold
        • certain antibiotics (e.g., imipenem and high-dose penicillin)
        • tricyclic antidepressants
        • bupropion
  • Pathogenesis
    • Uncontrolled neuronal excitation and reduced neuronal inhibition
  • Presentation
    • Symptoms/physical exam
      • symptoms depend on the location of the seizure
        • generalized tonic-clonic seizures with diffuse seizure activity
  • Imaging
    • CT head without contrast
      • indication
        • performed once the patient is stabilized to determine the presence of a stroke, intracranial bleed, or intracranial abnormality
    • MRI brain
      • indication
        • more sensitive imaging modality to visualize any underlying structural lesion; however, not necessary to be performed
          • the patient must be well enough to tolerate the length of the MRI
  • Studies
    • Electroencephalogram
      • indication
        • determins the presence of seizures and whether they terminated
          • patients can still have seizures without convulsions (called non-convulsive status epilepticus)
    • Serum studies
      • calcium, phosphorous, magnesium, and glucose level
      • antiseizure drug level
      • toxicology studies
  • Treatment
    • Medical
      • lorazepam or diazepam
        • indication
          • initial therapy to be administered in status epilepticus in 1 intravenous line
        • other medications
          • midazolam if intravenous access cannot be obtained
      • fosphenytoin, phenytoin, valproic acid, or levetiracetam
        • indication
          • initial therapy to be administered in status epilepticus in the other intravenous line
      • correcting underlying medical problem
        • e.g., correcting hypoglycemia
        • provide thiamine
      • midazolam, phenobarbitol, or pentobarbitol drip
        • indication
          • used in refractory status epilepticus
  • Complications
    • Cardiac arrhythmias
    • Hypoxia
    • Aspiration pneumonitis and respiratory failure
1 of 0
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options