Non-convulsive status epilepticus in the postanesthesia care unit following meningioma excision.
OBJECTIVE
Non-convulsive status epilepticus (NCSE) is an underdiagnosed clinical entity in which electrical seizures occur with subtle or no overt clinical manifestations. It can cause delayed recovery from anesthesia and constitutes an important differential diagnosis for prolonged postoperative unconsciousness. This condition can be diagnosed only by electroencephalogram (EEG), and the institution of early treatment is associated with better prognosis. This case is presented to illustrate the occurrence of this rare clinical entity in a patient who had undergone extradural surgery.


METHODS
An elderly female with no history of seizures or predisposing factors for convulsions underwent an uncomplicated left frontotemporal craniotomy for excision of an extradural meningioma. She was unresponsive following surgery, which could not be explained by the imaging and laboratory investigations. A subsequent EEG demonstrated periodic epileptiform discharges in lateralized left hemispheric distribution characteristic of seizures. The seizures were not effectively prevented by prophylactic fosphenytoin; however, the patient responded slowly to intravenous levetiracetam, which is known to be a more effective treatment for NCSE. The patient had no predisposing factors for the development of seizures and was undergoing an extradural surgery.


CONCLUSIONS
This case illustrates NCSE and emphasizes the importance of obtaining an electro-encephalogram early following craniotomy to diagnose any changes in the patient's mental status. This case also emphasizes that institution of early treatment is important to assure better prognosis.
Anesthesiology Institute, Cleveland Clinic, Cleveland, OH, USA.
Jagan
J
Devarajan
Amira Mohammed
AM
Siyam
Andreas V
AV
Alexopoulos
Robert
R
Weil
Ehab
E
Farag
D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000627:therapeutic use; D003399:Craniotomy / Q000009:adverse effects / Q000379:methods; D004569:Electroencephalography; D005260:Female; D006801:Humans; D000077287:Levetiracetam; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D010889:Piracetam / Q000031:analogs & derivatives / Q000627:therapeutic use; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology; D011997:Recovery Room; D013226:Status Epilepticus / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*
D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam