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

Research output: Contribution to journalArticle

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, 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.

Details

Authors
External organisations
  • Uppsala University Hospital
Research areas and keywords

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
Original languageEnglish
Pages (from-to)160-4
JournalNeurocritical Care
Volume7
Issue number2
Publication statusPublished - 2007
Publication categoryResearch
Peer-reviewedYes
Externally publishedYes