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Super Refractory Status Epilepticus in Hashimoto s Encephalopathy
#MMPMID28584608
Al-Busaidi M
; Burad J
; Al-Belushi A
; Gujjar A
Oman Med J
2017[May]; 32
(3
): 247-250
PMID28584608
show ga
We present a case of a 38-year-old woman who was at eight weeks of gestation and
was admitted to Sultan Qaboos University Hospital with refractory status
epilepticus (SE). She presented with a two-day history of fever and a depressed
level of consciousness that was followed with generalized tonic-clonic seizures.
She progressed to refractory SE that required intubation and mechanical
ventilation. Autoimmune workup was suggestive of Hashimoto's encephalopathy (HE)
as suggested by the high levels of thyroid antibodies. Her magnetic resonance
imaging showed bilateral hippocampal and basal ganglia hyperintensities, and
electroencephalogram showed bilateral frontal epileptiform discharges. Other
autoimmune workup was negative. Intravenous anesthetics were started including
propofol, midazolam, ketamine, and thiopentone. She was started on multiple
immunosuppressive therapies. Multiple antiepileptics were used including
phenytoin, lamotrigine, levetiracetam, sodium valproate, clobazam, phenobarbital,
and lacosamide. The outcome was unusual in terms of refractoriness to
immunotherapy treatment despite a confirmed diagnosis. We did a literature review
of all cases with HE presenting with SE with their clinical characteristics and
outcome.
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