Year: 2017
Type: article
Study design: Case Report
Abstract: A 43-year-old woman with a history of hypertension had a witnessed collapse while smoking crack cocaine. Immediate bystander cardiopulmonary resuscitation was performed for 15 minutes; total downtime was estimated at 30 minutes with return of spontaneous circulation (ROSC) achieved after defibrillation of ventricular fibrillation and a total of 5 mg IV epinephrine. Cardiac catheterization showed normal coronary vasculature. Initial neurologic examination 2 hours after fentanyl and vecuronium boluses was significant for nonreactive pupils, absent gag reflex, and no motor response to noxious stimulation, but intact corneal and oculocephalic reflexes. Head CT (obtained to rule out intracerebral hemorrhage in the setting of cocaine use) showed no acute abnormalities. Targeted temperature management (TTM) was initiated 3 hours after ROSC, targeting 32–34°C, and maintained for 24 hours. Continuous EEG initially showed a discontinuous pattern with widespread attenuation, followed by left temporal lateralized periodic discharges, and then by generalized spike and wave discharges. These EEG changes occurred during hypothermia and did not have any clinical correlate. The patient was treated with levetiracetam 55 mg/kg/d with improvement in hyperexcitable patterns. Ten hours after achieving normothermia, she developed frequent myoclonic jerking of her lower extremities, time-locked with epileptiform bursts, consistent with myoclonic status epilepticus (MSE) (figure 1A). Neurologic examination 48 hours after rewarming was unchanged, except for the development of 1–3 Hz myoclonic blinking and jerking of the upper and lower extremities.
Source: Neurology
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2771016972