Seizures in Critical Care (eBook)

Series Editor’s Introduction 6
Foreword 7
Preface 9
Contents 11
Contributors 13
Presentation and Pathophysiology of Seizures in the Critical Care Environment 15
SUMMARY 15
INTRODUCTION 16
CELLULAR PATHOPHYSIOLOGY OF ICU SEIZURES 20
CLINICAL MANIFESTATIONS AND DIAGNOSIS 24
OVERVIEW OF STATUS EPILEPTICUS 26
PAROXYSMAL LATERALIZING EPILEPTIFORM DISCHARGES ( PLEDS) 29
CONCLUSION 30
REFERENCES 31
Stroke and Critical Care Seizures 35
SUMMARY 35
INTRODUCTION 35
SEIZURES AFTER ISCHEMIC STROKE 36
INTRACEREBRAL HEMORRHAGE 57
SUBARACHNOID HEMORRHAGE 62
ARTERIOVENOUS MALFORMATIONS 72
REPERFUSION–HYPERPERFUSION SYNDROME 77
CEREBRAL VENOUS AND DURAL SINUS THROMBOSIS 81
REFERENCES 85
Traumatic Brain Injury and Seizures in the ICU 94
SUMMARY 94
INTRODUCTION 94
INCIDENCE OF SEIZURES IN TBI 95
EXPERIMENTAL APPROACHES TO POSTTRAUMATIC SEIZURES 101
PATHOPHYSIOLOGY OF POSTTRAUMATIC SEIZURES 102
DIAGNOSIS OF SEIZURES 104
TREATMENT OF POSTTRAUMATIC SEIZURES 105
OUTCOME OF SEIZURES COMPLICATING TBI 108
REFERENCES 109
Brain Tumors and ICU Seizures 114
SUMMARY 114
INTRODUCTION 114
INCIDENCE 115
CLINICAL PRESENTATION 116
PATHOPHYSIOLOGY 117
EVALUATION OF PATIENTS WITH ICU SEIZURES 118
TREATMENT 122
OUTCOME 127
REFERENCES 127
Global Hypoxia–Ischemia and Critical Care Seizures 131
SUMMARY 131
INTRODUCTION 132
EPIDEMIOLOGY 132
PATHOPHYSIOLOGY 133
CLINICAL PRESENTATION 135
LABORATORY INVESTIGATION 137
DIFFERENTIAL DIAGNOSIS 141
TREATMENT 144
PROGNOSIS AND OUTCOMES 146
ACKNOWLEDGMENTS 147
REFERENCES 147
Seizures in Renal and Hepatic Failure and Endocrine Disease 151
SUMMARY 151
INTRODUCTION 151
ORGAN FAILURE 152
ENDOCRINE DISEASE 162
REFERENCES 168
Seizures in Organ Transplant Recipients 173
SUMMARY 173
INCIDENCE OF SEIZURES IN TRANSPLANT PATIENTS 173
CLINICAL EVALUATION OF PATIENTS 176
ETIOLOGY OF SEIZURES IN TRANSPLANT PATIENTS 177
DIAGNOSTIC EVALUATION 180
MANAGEMENT OF SEIZURES 181
CASE STUDIES 184
REFERENCES 187
Extreme Hypertension, Eclampsia, and Critical Care Seizures 189
SUMMARY 189
INTRODUCTION 189
HYPERTENSION AND PREGNANCY 190
HYPERTENSIVE ENCEPHALOPATHY 195
POSTERIOR LEUKOENCEPHALOPATHY SYNDROME 197
REFERENCES 200
Infection or Inflammation and ICU Seizures 203
SUMMARY 203
INTRODUCTION 203
CNS INFECTIOUS DISORDERS 204
VASCULITIDES 216
REFERENCES 222
Electrolyte Disturbance and Critical Care Seizures 229
SUMMARY 229
INTRODUCTION 229
MECHANISMS FOR ION REGULATION AND EFFECTS OF CONCENTRATION CHANGES 230
SODIUM IMBALANCE 231
HYPOMAGNESEMIA 238
DISORDERS OF CA2+ HOMEOSTASIS 241
HYPOPHOSPHATEMIA 243
REFERENCES 244
Alcohol-Related Seizures in the ICU 249
SUMMARY 249
INTRODUCTION 249
ALCOHOL WITHDRAWAL SYNDROME 250
ALCOHOL-RELATED SEIZURES 251
PATHOPHYSIOLOGY OF ARS 258
COMORBID MEDICAL CONDITIONS 259
EVALUATION 259
TREATMENT 261
REFERENCES 267
Seizure-Inducing Drugs Used for the Critically Ill 272
SUMMARY 272
INTRODUCTION 273
ELECTROLYTE MANAGEMENT 275
ENDOCRINE MANAGEMENT 275
TOPICAL ANESTHETICS 276
PSYCHOTROPICS AND NEUROLEPTICS 277
ANTIEPILEPTIC AGENTS 282
CENTRAL NERVOUS SYSTEM STIMULANTS 285
ANTIASTHMATIC MEDICATIONS 286
ANALGESICS 287
ANTIBIOTIC AGENTS 288
ANTIVIRALS 294
IMMUNOMODULATORS 296
CHEMOTHERAPEUTIC AGENTS 297
OTHER COMMON ICU DRUGS 297
REFERENCES 297
Critical Care Seizures Related to Illicit Drugs and Toxins 302
SUMMARY 302
INTRODUCTION 302
ILLICIT DRUGS 303
EPILEPTOGENIC ENVIRONMENTAL TOXINS 306
CONCLUSION 311
REFERENCES 311
Management of Status Epilepticus and Critical Care Seizures 316
SUMMARY 316
INTRODUCTION 316
DEFINITION 317
CLASSIFICATION 318
INCIDENCE AND CLINICAL PRESENTATION 319
ETIOLOGY 321
DIFFERENTIAL DIAGNOSIS 325
ELECTROENCEPHALOGRAPHY 326
OUTCOME 328
GOALS OF ICU MANAGEMENT OF SEIZURES AND SE 330
MANAGEMENT OF FOCAL SE 359
MANAGEMENT OF SEIZURES AND SE WITH ANTIEPILEPTICS IN ICU PATIENTS WITH ORGAN DYSFUNCTION 362
DRUG INTERACTION IN THE ICU 366
REFERENCES 366
Index 376