scholarly journals Cefepime-Induced Encephalopathy and Nonconvulsive Status Epilepticus: Dispelling an Artificial Dichotomy

2018 ◽  
Vol 9 (2) ◽  
pp. 100-104 ◽  
Author(s):  
Dmitry Tchapyjnikov ◽  
Matthew W. Luedke
Keyword(s):  
Status Epilepticus ◽  
Mental Status ◽  
Case Series ◽  
Generation Cephalosporin ◽  
Nonconvulsive Status Epilepticus ◽  
Fourth Generation ◽  
Definitive Treatment ◽  
Transient Improvement ◽  
Cephalosporin Antibiotic ◽  
Electroencephalogram Eeg

Cefepime is a fourth-generation cephalosporin antibiotic known to have neurotoxic side effects. Recent reports have described patients on cefepime presenting with altered mentation and concurrent triphasic wave discharges on electroencephalogram (EEG). Some have described this clinical presentation as cefepime-induced encephalopathy, while others have termed it as cefepime-induced nonconvulsive status epilepticus (NCSE). We report on 4 patients who developed cefepime-associated altered mentation with triphasic discharges on EEG. A benzodiazepine trial was attempted in 3 of the patients, all of whom had improvement in the frequency of the triphasic discharges, but only 2 of whom demonstrated a concurrent partial and transient improvement in mental status. All 4 patients had normalization of mental status upon discontinuation of cefepime. We provide a literature review of prior cases and propose that these reports, including those labeled as NCSE, are best described as a cefepime-induced encephalopathy with triphasic discharges as opposed to an ictal phenomenon. We contend that aggressive treatment with anti-seizure medications is not warranted and that cefepime discontinuation is the definitive treatment. This case series and review of the literature clarifies a long-standing terminological ambiguity in a unique clinical picture that can be encountered by the neurohospitalist or other providers.

scholarly journals Fat Embolism and Nonconvulsive Status Epilepticus

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Yanetsy Olivera Arencibia ◽  
Mai Vo ◽  
Jennifer Kinaga ◽  
Jorge Uribe ◽  
Gloria Velasquez ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Mental Status ◽  
Supportive Therapy ◽  
Altered Mental Status ◽  
Fat Embolism ◽  
Nonconvulsive Status Epilepticus ◽  
Altered Level ◽  
Fat Embolism Syndrome ◽  
Embolism Syndrome ◽  
Wide Range

Fat embolism syndrome (FES) typically occurs following orthopedic trauma and may present with altered mental status and even coma. Nonconvulsive status epilepticus is an electroclinical state associated with an altered level of consciousness but lacking convulsive motor activity and has been reported in fat embolism. The diagnosis is clinical and is treated with supportive care, antiepileptic therapy, and sedation. A 56-year-old male presented with altered mental status following internal fixation for an acute right femur fracture due to a motor vehicle accident 24 hours earlier. Continued neuromonitoring revealed nonconvulsive status epilepticus. Magnetic resonance imaging of the brain showed multiple bilateral acute cerebral infarcts with a specific pattern favoring the diagnosis of fat embolism syndrome. He was found to have a significant right to left intracardiac shunt on a transesophageal echocardiogram. He improved substantially over time with supportive therapy, was successfully extubated on day 6, and discharged to inpatient rehabilitation on postoperative day 15. Fat embolisms can result in a wide range of neurologic manifestations. Nonrefractory nonconvulsive status epilepticus that responds to antiepileptic drugs, sedation, and supportive therapy can have a favorable outcome. A high index of suspicion and early recognition reduces the chances of unnecessary interventions and may improve survival.

Nonconvulsive Status Epilepticus on Electroencephalography in a Case With Subacute Sclerosing Panencephalitis

2006 ◽  
Vol 21 (3) ◽  
pp. 256-260
Author(s):  
Ömer Faruk Aydin ◽  
Nesrin Şenbil ◽  
Y. K. Yavuz Gürer
Keyword(s):  
Status Epilepticus ◽  
Subacute Sclerosing Panencephalitis ◽  
Closed Head Injury ◽  
High Amplitude ◽  
Nonconvulsive Status Epilepticus ◽  
Computed Tomographic ◽  
Cognitive Difficulties ◽  
Intravenous Diazepam ◽  
Electroencephalogram Eeg ◽  
The Brain

Subacute sclerosing panencephalitis is a neurodegenerative disease with a poor prognosis. We report a case of a 5Z\x-year-old boy who had emotional lability, cognitive difficulties, and myoclonia after a mild closed head injury. The magnetic resonance image of the brain and computed tomographic scan of the head were normal. His electroencephalogram (EEG) showed continuous nonconvulsive status epilepticus activity, which could not be suppressed with intravenous diazepam. After treatment with phenytoin for 2 days, an EEG showed periodic high-amplitude sharp-and-slow-wave complexes, which were also not suppressed with intravenous diazepam. Since the patient had measles at 5 months of age, subacute sclerosing panencephalitis was considered, and the diagnosis was confirmed by the presence of measles antibodies in cerebrospinal fluid. ( J Child Neurol 2006;21:256—260; DOI 10.2310/7010.2006.00056).

scholarly journals 1146. Lactococcus species Catheter-Related Bloodstream Infections in Pediatrics: A Case Series

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S665-S665
Author(s):  
Sarah E Firmani ◽  
Holly Maples ◽  
Archana Balamohan
Keyword(s):  
United States ◽  
Case Series ◽  
The United States ◽  
Generation Cephalosporin ◽  
Definitive Treatment ◽  
Common Source ◽  
Beta Lactam ◽  
Sensitivity Testing ◽  
Pubmed Database ◽  
Definitive Therapy

Abstract Background Central venous catheters (CVC), may lead to central line-associated blood stream infections (CLABSIs). In the past, Lactococcus species have seldom been considered pathogenic. However, clinically significant infections have been reported, of which few are pediatric cases, all outside the United States. Methods We retrospectively identified pediatric patients with bacteremia secondary to Lactococcus spp. admitted to a tertiary pediatric hospital from January 2018 - December 2020. We reviewed the PubMed database for cases of pediatric Lactococcus spp. infections in English, peer-reviewed literature. Results We identified 3 patients with Lactococcus spp. bacteremia. The average patient was 17 months old (range, 6–24 months). All had a CVC; two had short bowel syndrome and 1 had nephrotic syndrome. None received probiotics. Empiric treatment for all included vancomycin. Two of 3 patients were de-escalated to ceftriaxone. All isolates were susceptible to penicillin. Duration of treatment was 10-14 days. Two of 3 were managed with CVC retention and none had recurrence of infection. A literature review revealed 9 additional cases (Table 1). The most common source of infection was blood (33%), with 66% (2/3) occurring in patients with central lines. Other sources included liver abscess (11%), brain abscess (11%), cerebrospinal fluid (11%), urine (11%), and endocarditis (22%). Median patient age was 12 months (range, 14 days-14 years). Five of 9 patients had an underlying risk factor. Duration of therapy ranged from 7-40 days. Most definitive treatment regimens consisted of a third-generation cephalosporin (44%). Of bacteremia, 2/3 received vancomycin as part of their definitive therapy. Five of 9 reported quantitative antimicrobial sensitivity testing (AST) or interpretation of AST to beta-lactam antibiotics; 80% (4/5) were susceptible. Conclusion To the best of our knowledge, these are the first reported pediatric cases of Lactococcus infections in the United States and suggests Lactococcus spp. should be considered pathogenic in the appropriate circumstances. This series adds to the limited literature, including AST. Continued accrual of susceptibility data may raise the possibility of using a 3rd generation cephalosporin as empiric therapy for Lactococcus bacteremia. Disclosures All Authors: No reported disclosures

Nonconvulsive status epilepticus in cancer patients with altered mental status.

2014 ◽  
Vol 32 (15_suppl) ◽  
pp. e13028-e13028
Author(s):  
Barbara Jane O'Brien ◽  
Jacob Joseph Mandel ◽  
Tummala Sudhakar ◽  
John Frederick De Groot
Keyword(s):  
Status Epilepticus ◽  
Cancer Patients ◽  
Mental Status ◽  
Altered Mental Status ◽  
Nonconvulsive Status Epilepticus

scholarly journals StatNet Electroencephalogram: A Fast and Reliable Option to Diagnose Nonconvulsive Status Epilepticus in Emergency Setting

2016 ◽  
Vol 43 (2) ◽  
pp. 254-260 ◽  
Author(s):  
Lady Diana Ladino ◽  
Alexandra Voll ◽  
Dianne Dash ◽  
Wes Sutherland ◽  
Lizbeth Hernández-Ronquillo ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Setup Time ◽  
Observer Agreement ◽  
Nonconvulsive Status Epilepticus ◽  
University Hospital ◽  
Emergency Setting ◽  
Study Quality ◽  
Hospital Emergency ◽  
Kappa Score ◽  
Electroencephalogram Eeg

AbstractBackground: The StatNet electrode set is a system that can be applied by a non-electroencephalogram (EEG) technologist after minimal training. The primary objectives of this study are to assess the quality and reliability of the StatNet recordings in comparison to the conventional EEG. Methods: Over 10 months, 19 patients with suspected nonconvulsive status epilepticus were included from university hospital emergency settings. Each patient received a StatNet EEG by a trained epilepsy fellow and a conventional EEG by registered technologists. We compared the studies in a blinded fashion, for the timeframe from EEG order to the setup time, start of acquisition, amount of artifact, and detection of abnormalities. The nonparametric Mann-Whitney two-sample t test was used for comparisons. The kappa score was used to assess reliability. Results: Mean age of patients was 61±16.3 (25-93) years. The inter-observer agreement for detection of abnormal findings was 0.83 for StatNet and 0.75 for conventional EEG. Nonconvulsive status epilepticus was detected in 10% (2/19) in both studies. The delay from the time of EEG requisition to acquisition was shorter in the StatNet (22.4±2.5 minutes) than the conventional EEG (217.7±44.6 minutes; p<0.0001). The setup time was also shorter in the StatNet (9.9±0.8 minutes) compared with the conventional EEG (17.8±0.8 minutes; p<0.0001). There was no difference in the percentage of artifact duration between the two studies (p=0.89). Conclusion: This study demonstrates that StatNet EEG is a practical and reliable tool in the emergency setting, which reduces the delay of testing compared with conventional EEG, without significant compromise of study quality.

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