title: [Clinical misdiagnosis analysis of valproate encephalopathy].
abstract: OBJECTIVE
  To analyze the clinical and laboratory characteristics of postoperative patients of valproate encephalopathy (VHE), summarize the diagnostic and treatment experiences, discuss the reason of misdiagnosis and improve the level of early diagnosis.
  
  
  METHODS
  A total of 12 VHE patients diagnosed after an application of valproate were recruited from January 2010 to April 2013. The characteristics of clinical manifestations and laboratory examinations were retrospectively analyzed.
  
  
  RESULTS
  Among them, the misdiagnoses included intracranial hemorrhage (n = 1), secondary brain edema (n = 1), postoperative cerebral infarction (n = 1), postoperative epileptic deterioration (n = 4), electrolyte disorder (n = 2), intracranial infection (n = 1), vasospasm (n = 1) and non-specific (n = 1). All patients had disturbance of consciousness associated with elevated blood ammonia. The symptoms of VHE were not correlated with the dosage and concentration of valproate. VHE was more likely to occur in patients treated with valproic acid sodium injection or other antiepileptic drugs. The symptoms dramatically improved after a withdrawal of valproate.
  
  
  CONCLUSIONS
  VHE should be considered in postoperative neurosurgical valproate-treated patients with unknown disturbance of consciousness. Timely diagnosis is needed and valproate should be withdrawn to avoid serious consequences.
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Danhua
authors.initials: D
authors.lastname: Zhu
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Zhipeng
authors.initials: Z
authors.lastname: Su
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Ye
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Xianbin
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China.
authors.forename: Gichuan
authors.initials: G
authors.lastname: Zhuge
authors.affiliation: Department of Neurosurgery, First Affiliated Hospital, Wenzhou Medical University, Wenzhou 325000, China. Email: zhebao.wu@gmail.com.
authors.forename: Zhebao
authors.initials: Z
authors.lastname: Wu
mesh_terms: D000927:Anticonvulsants; D001927:Brain Diseases; D001929:Brain Edema; D001932:Brain Neoplasms; D003951:Diagnostic Errors; D004827:Epilepsy; D006801:Humans; D020300:Intracranial Hemorrhages; D014635:Valproic Acid / Q000009:adverse effects*; D014652:Vascular Diseases; D014661:Vasoconstriction
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid