• Niklas Marklund, Per Enblad, and Elisabeth Ronne-Engström.
• Department of Neuroscience, Uppsala University Hospital, Uppsala, 75185 Sweden. Niklas.Marklund@neurokir.uu.se
• Neurocrit Care. 2007 Jan 1;7(2):160-4.

IntroductionWe 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.MethodsThe 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.ResultsThere 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.ConclusionWe conclude that NIC may be an important treatment option in cases of severe intoxication causing cerebral swelling.

25 keywords...

hide…