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Neurointensive care management of raised intracranial pressure caused by severe valproic acid intoxication
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Neurosurgery.
2007 (English)In: Neurocritical care, ISSN 1541-6933, Vol. 7, no 2, 160-164 p.Article in journal (Refereed) Published
Abstract [en]

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 mu mol/l. The patient deteriorated to Glasgow Motor Scale score (GMS) 2 and a CT scan showed signs of raised lCP. 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.

Place, publisher, year, edition, pages
2007. Vol. 7, no 2, 160-164 p.
Keyword [en]
neurointensive care, intracranial pressure, EEG monitoring, cerebral swelling, valproic acid, intoxication
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-143338DOI: 10.1007/s12028-007-0060-6ISI: 000249741700012OAI: oai:DiVA.org:uu-143338DiVA: diva2:390304
Available from: 2011-01-21 Created: 2011-01-20 Last updated: 2011-01-21Bibliographically approved

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