Leaking the Diagnosis: A Case of Convulsive Status Epilepticus Due to Intracranial Hypotension

Neurocritical Care
Gabriela S GilmourPhilippe Couillard

Abstract

We describe a case of convulsive status epilepticus caused by intracranial hypotension, a complication of spinal surgery. Intracranial hypotension (IH) is typically characterized by an orthostatic headache. There have been limited case reports describing surgery-associated IH presenting with seizures. Case report and review of the literature. A 71-year-old woman with chronic back pain developed convulsive status epilepticus, characterized by generalized clonic seizures, immediately following scoliosis surgery. She had no history of seizures or other seizure risk factors. Despite treatment with intravenous midazolam, phenytoin, and lacosamide, seizures recurred five times over three hours. Thus, propofol and midazolam infusions were initiated. An electroencephalogram revealed burst suppression and bilateral hemispheric epileptiform discharges. Magnetic resonance imaging of the brain was consistent with IH without cortical vein thrombosis. Fluid from the surgical drains was positive for Beta-2 transferrin, consistent with cerebral spinal fluid. Her IH was likely due to an intraoperative dural tear causing status epilepticus. Over two weeks, she remained on bed rest, sedation was weaned, and phenytoin and lacosamide were tapered a...Continue Reading

References

Mar 20, 2002·Current Neurology and Neuroscience Reports·B Mokri
Sep 21, 2004·Neurosurgical Focus·Charles L Rosen
Apr 26, 2006·Pediatric Neurosurgery·Deepak Agrawal, Felix A Durity
May 18, 2006·JAMA : the Journal of the American Medical Association·Wouter I Schievink
Dec 16, 2010·The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques·N ChaudharyN Duggal
Aug 27, 2013·Journal of Neurosurgery·Vishnumurthy Shushrutha HednaStephan Eisenschenk
Dec 25, 2013·Handbook of Clinical Neurology·Mamede de Carvalho, Michael Swash
Jun 12, 2016·Journal of the Neurological Sciences·Asaf HonigRonen R Leker
Jul 30, 2017·Current Pain and Headache Reports·Peter G KranzLinda Gray

❮ Previous
Next ❯

Related Concepts

Related Feeds

CSF & Lymphatic System

This feed focuses on Cerebral Spinal Fluid (CSF) and the lymphatic system. Discover the latest papers using imaging techniques to track CSF outflow into the lymphatic system in animal models.