Nonconvulsive Status Epilepticus

Collapsed

Step 1: View clinicals

A 23 year old woman presents 8 hours after a convulsion, following which she has been continuously confused. She was camping in the wilderness along with her partner, who witnessed the episode. He saw her collapse to the ground, with jerky movements of all four limbs and frothing at the mouth. This lasted for around 2 minutes. Her medical and surgical histories are unremarkable, but her family history is significant for a sister with epilepsy. She only drinks socially, is not on any medications, and does not use recreational drugs.


Step 2: Order all relevant investigations

Metabolic Profile

Random Blood Glucose: 96 mg/dL (79-140) Sodium: 135 mEq/L (135-145) Potassium: 4.5 mEq/L (3.5-5.0) Chloride: 98 mEq/L (96-106) Calcium: 4.5 mEq/dL (4.3-5.3) Magnesium: 1.5 mEq/dL (1.5-2.5)

CT Brain

The CT scan of the brain appears normal.

Lumbar Puncture

Appearance: clear Cell count: 2 cells/mm3 (<5 cells) Protein: 25 mg/dl (15-40) Glucose: 62 mg/dL (½ to ⅔ of blood glucose) Random Blood Glucose: 96 mg/dL

EEG

The EEG reveals generalized cortical spike and slow wave discharges.


Step 3: Select appropriate management

Benzodiazepines
IV Antibiotics
ICU Care
IV Glucose Stat


Score: ★★☆