Neurointensive care management of raised intracranial pressure caused by severe valproic acid intoxication
2007 (English)In: Neurocritical care, ISSN 1541-6933, Vol. 7, no 2, 160-164 p.Article in journal (Refereed) Published
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.
neurointensive care, intracranial pressure, EEG monitoring, cerebral swelling, valproic acid, intoxication
Medical and Health Sciences
IdentifiersURN: urn:nbn:se:uu:diva-143338DOI: 10.1007/s12028-007-0060-6ISI: 000249741700012OAI: oai:DiVA.org:uu-143338DiVA: diva2:390304