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Neurointensive care management of raised intracranial pressure caused by severe valproic acid intoxication

Marklund, Niklas LU ; Enblad, Per and Ronne-Engström, Elisabeth (2007) In Neurocritical Care 7(2). p.4-160
Abstract

INTRODUCTION: We describe the neurointensive care (NIC) management of a patient with severe cerebral swelling and raised intracranial pressure (ICP) after severe sodium valproic acid (VPA) intoxication. A previously healthy 25-year old male with mild tonic-clonic epilepsy was found unconscious with serum VPA levels >10,000 micromol/l. The patient deteriorated to Glasgow Motor Scale score (GMS) 2 and a CT scan showed signs of raised ICP. Early ICP was elevated, >50 mm Hg, and continuous EEG monitoring showed isoelectric readings.

METHODS: The patient was treated with an ICP-guided protocol including mild hyperventilation, normovolemia, head elevation and intermittent doses of mannitol. Due to refractory elevations of ICP,... (More)

INTRODUCTION: We describe the neurointensive care (NIC) management of a patient with severe cerebral swelling and raised intracranial pressure (ICP) after severe sodium valproic acid (VPA) intoxication. A previously healthy 25-year old male with mild tonic-clonic epilepsy was found unconscious with serum VPA levels >10,000 micromol/l. The patient deteriorated to Glasgow Motor Scale score (GMS) 2 and a CT scan showed signs of raised ICP. Early ICP was elevated, >50 mm Hg, and continuous EEG monitoring showed isoelectric readings.

METHODS: The patient was treated with an ICP-guided protocol including mild hyperventilation, normovolemia, head elevation and intermittent doses of mannitol. Due to refractory elevations of ICP, high-dose pentobarbital infusion was initiated, and ICP gradually normalised.

RESULTS: There were several systemic complications including coagulopathy, hypocalcemia and pancreatitis. The patient remained in a depressed level of consciousness for 2 months but gradually recovered, showing a good recovery with minor subjective cognitive deficits by 6 months.

CONCLUSION: We conclude that NIC may be an important treatment option in cases of severe intoxication causing cerebral swelling.

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publication status
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keywords
Adult, Anticonvulsants, Brain Edema, Critical Care, Epilepsy, Tonic-Clonic, Humans, Intracranial Hypertension, Male, Monitoring, Physiologic, Severity of Illness Index, Tomography, X-Ray Computed, Valproic Acid, Case Reports
in
Neurocritical Care
volume
7
issue
2
pages
4 - 160
publisher
Humana Press
external identifiers
  • scopus:36949005414
  • pmid:17522786
ISSN
1541-6933
DOI
10.1007/s12028-007-0060-6
language
English
LU publication?
no
id
f9bda666-6fc7-4767-9a69-fdf55d1f05de
date added to LUP
2018-03-03 14:40:15
date last changed
2021-02-17 01:48:52
@article{f9bda666-6fc7-4767-9a69-fdf55d1f05de,
  abstract     = {<p>INTRODUCTION: We describe the neurointensive care (NIC) management of a patient with severe cerebral swelling and raised intracranial pressure (ICP) after severe sodium valproic acid (VPA) intoxication. A previously healthy 25-year old male with mild tonic-clonic epilepsy was found unconscious with serum VPA levels &gt;10,000 micromol/l. The patient deteriorated to Glasgow Motor Scale score (GMS) 2 and a CT scan showed signs of raised ICP. Early ICP was elevated, &gt;50 mm Hg, and continuous EEG monitoring showed isoelectric readings.</p><p>METHODS: The patient was treated with an ICP-guided protocol including mild hyperventilation, normovolemia, head elevation and intermittent doses of mannitol. Due to refractory elevations of ICP, high-dose pentobarbital infusion was initiated, and ICP gradually normalised.</p><p>RESULTS: There were several systemic complications including coagulopathy, hypocalcemia and pancreatitis. The patient remained in a depressed level of consciousness for 2 months but gradually recovered, showing a good recovery with minor subjective cognitive deficits by 6 months.</p><p>CONCLUSION: We conclude that NIC may be an important treatment option in cases of severe intoxication causing cerebral swelling.</p>},
  author       = {Marklund, Niklas and Enblad, Per and Ronne-Engström, Elisabeth},
  issn         = {1541-6933},
  language     = {eng},
  number       = {2},
  pages        = {4--160},
  publisher    = {Humana Press},
  series       = {Neurocritical Care},
  title        = {Neurointensive care management of raised intracranial pressure caused by severe valproic acid intoxication},
  url          = {http://dx.doi.org/10.1007/s12028-007-0060-6},
  doi          = {10.1007/s12028-007-0060-6},
  volume       = {7},
  year         = {2007},
}