scholarly journals Nonconvulsive Status Epilepticus in Patients with Altered Mental Status Admitted to Hamad General Hospital, Doha, Qatar

2019 ◽  
Author(s):  
Boulenouar Mesraoua ◽  
Dirk Deleu ◽  
Hassan Al Hail ◽  
Musab Ali ◽  
Naim Haddad ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
General Hospital ◽  
Mental Status ◽  
Altered Mental Status ◽  
Nonconvulsive Status Epilepticus

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 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

Clinical Characteristics and Nonconvulsive Seizures in Young Children With Abusive Head Trauma

2019 ◽  
Vol 34 (12) ◽  
pp. 713-719
Author(s):  
Ahyuda Oh ◽  
Larry D. Olson ◽  
Joshua J. Chern ◽  
Hyunmi Kim
Keyword(s):  
Status Epilepticus ◽  
Head Trauma ◽  
Mental Status ◽  
Abusive Head Trauma ◽  
Altered Mental Status ◽  
Nonconvulsive Status Epilepticus ◽  
Fisher Exact Test ◽  
Short Term ◽  
Nonconvulsive Seizures ◽  
The Impact

Aim: We aimed to evaluate putative predictors of symptoms and signs at admission for nonconvulsive seizure and to examine the impact of nonconvulsive seizures on short-term outcomes. Method: We retrospectively collected consecutive abusive head trauma patients (<36 months of age) from the trauma registry at Children’s Healthcare of Atlanta between 2009 and 2014. Multiple logistic regression was performed to assess the putative predictors for the occurrence of nonconvulsive seizures including clinical seizures, altered mental status, respiratory difficulty, and cardiac arrest at admission, while controlling for age, sex, and injury severity. The Mann-Whitney U test and the Fisher exact test were used to compare the short-term outcomes between patients with and without nonconvulsive seizures. Results: Two hundred seventy patients with abusive head trauma were identified (male = 55.6%). The median age was 4 months (interquartile range = 2-8 months). Among 70 patients who underwent continuous electroencephalography (EEG), 40 had nonconvulsive seizures (57%) and 21 developed nonconvulsive status epilepticus (30%). Altered mental status at admission was associated with the occurrence of nonconvulsive seizures (odds ratio = 6.8, 95% confidence interval = 1.2-38.2, P = .03). Comparing patients with no seizures, those with nonconvulsive seizures were more likely to stay longer at hospital (9 days vs 14 days, P = .04) and to need rehabilitation (50.0% vs 63.2%, P = .03). Conclusions: Nonconvulsive seizures and nonconvulsive status epilepticus was highly prevalent in young pediatric patients with abusive head trauma. Presenting with altered mental status at admission was found to predict the occurrence of nonconvulsive seizures. Nonconvulsive seizures had an unfavorable impact on short-term outcomes.

scholarly journals Sudden altered mental state in the elderly: nonconvulsive status epilepticus and the role of the Emergency Department

2011 ◽  
Vol 5 (1) ◽  
pp. 15-25
Author(s):  
Rocco Galimi
Keyword(s):  
Status Epilepticus ◽  
Seizure Activity ◽  
The Elderly ◽  
Altered Mental Status ◽  
Nonconvulsive Status Epilepticus ◽  
Recurrent Seizure ◽  
Memory Problems ◽  
Altered Mental State ◽  
New Onset

In the elderly, new onset of epilepsy is often associated with vague complaints such as confusion, altered mental status, or memory problems. The absence of clinically apparent convulsions in association with an electroencephalogram showing continuous or recurrent seizure activity has been called nonconvulsive status epilepticus (NCSE). The purpose of this article is to describe the clinical and electroencephalographic features of NCSE in older adults. NCSE is an important, under-recognised and reversible cause of acute prolonged confusion. Although attempts have been made to define and classify this disorder, there is no universally accepted definition or classification yet that encompasses all subtypes or electroclinical scenarios. A urgent electroencephalogram is considered as the method of choice in the diagnostic evaluation of NCSE. Further researches are needed to better define NCSE.

scholarly journals Non-convulsive status epilepticus: an often-overlooked etiology of syndrome of inappropriate antidiuretic hormone secretion

2017 ◽  
Vol 5 (5) ◽  
pp. 2251
Author(s):  
Elizabeth Davis ◽  
Rima Chakraborty
Keyword(s):  
Differential Diagnosis ◽  
Status Epilepticus ◽  
Mental Status ◽  
Hormone Secretion ◽  
Altered Mental Status ◽  
Convulsive Status Epilepticus ◽  
Chronic Medical Conditions ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Antidiuretic Hormone Secretion ◽  
Chronic Hyponatremia

Altered mental status is a common presenting complaint in adult medicine with a broad differential diagnosis. When found in the context of chronic medical conditions, less common etiologies can be overlooked. We present a case of acute altered mental status thought to be secondary to acute on chronic hyponatremia in the context of syndrome of inappropriate antidiuretic hormone secretion (SIADH), eventually diagnosed as non-convulsive status epilepticus, partial type. We report the case of a 67-year-old patient with known SIADH of unknown etiology, hypertension, chronic pancreatitis and chronic obstructive pulmonary disease (COPD) who presented with fatigue, myalgia, decreased urine output. On presentation patient also had profound acute on chronic hyponatremia. During sodium correction, the patient developed an acute, progressive decline in mental status. Vital signs remained stable and workup including LP and MRI were negative. Initial electroencephalographic (EEG) showed no definitive seizure activity, but did show bifrontal focal continuous slowing. The patient’s mental status continued to decline and upon further evaluation it was suggested that the EEG findings and the patient’s progressive AMS could be compatible with non-convulsive status epilepticus. The patient received loading doses of IV lorazepam and levetiracetam and within 48 hours after initial treatment was back to baseline. Non-convulsive status epilepticus is a common, but heterogeneous subclass of status epilepticus that is difficult to diagnose. This case demonstrates the difficulty of diagnosing normalized corrected Shannon entropy (NCSE) in the context of other chronic medical conditions and the importance of including it on any differential diagnosis for acute change in mental status. 

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.

Sign in / Sign up

Export Citation Format

Share Document