Microdialysis Findings in a Patient with New Onset Refractory Non-convulsive Status Epilepticus

A burst suppression pattern was recorded on EEG within minutes after administering a fractionated bolus of 486 mg thiopental (8.4 mg/kg) and concurrently raising the continuous infusion rate to 4 mg/kg/h (Fig. 2). [...]microdialysis levels of both pyruvate and glutamate dropped to the minima of 229...

Full description

Saved in:
Bibliographic Details
Published in:Neurocritical care 2020-06, Vol.32 (3), p.889-893
Main Authors: Hurth, Helene, Schlak, Dennis, Ebner, Florian Heinrich
Format: Article
Language:English
Subjects:
Anticonvulsants - therapeutic use
Catheters
Cerebrospinal fluid
Convulsions & seizures
Critical Care Medicine
Electroencephalography
Encephalitis
Epilepsy
Female
Frontal Lobe - metabolism
Frontal Lobe - physiopathology
Glucose
Glucose - metabolism
Glutamic Acid - metabolism
Glycerol
Humans
Immunoglobulins, Intravenous - therapeutic use
Immunologic Factors - therapeutic use
Intensive
Internal Medicine
Lactic Acid - metabolism
Limbic Encephalitis - diagnosis
Limbic Encephalitis - drug therapy
Limbic Encephalitis - metabolism
Limbic Encephalitis - physiopathology
Magnetic resonance imaging
Medicine
Medicine & Public Health
Metabolism
Microdialysis
Middle Aged
Neurology
Patients
Practical Pearl
Pyruvic Acid - metabolism
Ratios
Status Epilepticus - drug therapy
Status Epilepticus - metabolism
Status Epilepticus - physiopathology
Traumatic brain injury
Weaning
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:A burst suppression pattern was recorded on EEG within minutes after administering a fractionated bolus of 486 mg thiopental (8.4 mg/kg) and concurrently raising the continuous infusion rate to 4 mg/kg/h (Fig. 2). [...]microdialysis levels of both pyruvate and glutamate dropped to the minima of 229 µmol/L and 29 µmol/L, respectively, during the next 10 h. After three measurements of glutamate levels between 29 and 34 µmol/L, the glutamate started to increase again. Due to a further increase in glutamate, another EEG was performed another 10 h later and then showed a reoccurring NCSE. [...]another 750 mg (12.9 mg/kg) of fractionated thiopental was administered, which led to a sustained burst suppression pattern. [...]before administering the second bolus of thiopental, there was no normalization of glutamate despite a sustained burst suppression pattern on EEG over 24 h. The prolonged elevation of glutamate led to the performance of another EEG after another 12 h, and a recurrent NCSE was confirmed. [...]cerebral microdialysis could be an early indicator of antiepileptic weaning failure in addition to continuous EEG monitoring.
ISSN:1541-6933
1556-0961
DOI:10.1007/s12028-019-00848-8