Abstract
Seizures may herald, complicate, or become persistent sequellae of acute neurologic disorders such as acute cerebrovascular insult (stroke or hemorrhage), bacterial or viral meningoencephalitis, and head trauma. The occurrence of seizures in patients with primary neurological insults invariably adds an additional layer of complexity to patient management. For example, diminished arousal after generalized tonic-clonic seizures or status epilepticus (SE) may put a patient at risk for aspiration or hypoxia and may warrant airway protection via intubation and mechanical ventilation. Many patients will develop aspiration pneumonia. Phasic and substantial increases in intracranial pressure (ICP) during generalized tonic clonic seizures may lead to brain herniation in the setting of an existing mass lesion such as an acute stroke, hemorrhage, or brain tumor. Increased mean arterial blood pressure (MAP), hypoxemia, and metabolic or respiratory acidosis may accompany generalized tonic-clonic seizures and complicate the management of patients with acute stroke, sepsis, cardiac ischemia, or pulmonary edema Finally, systemic toxicity of antiepileptic drugs (AEDs) may be encountered and cause medical complications such as cardiac dysrhythmia, hypotension, the Stevens—Johnson syndrome, other hypersensitivity reactions, and hepatic failure. Some of these complications may be life threatening even if the underlying neurologic event is not. It is important for the clinician, whether in the outpatient, hospital ward, or Emergency Department setting, to remember that a first-time seizure may herald a potentially significant and even disastrous neurologic event. This chapter will focus on the etiologic, diagnostic, and treatment implications of seizures in several acute neurologic disorders such as arterial and venous cerebral infarcts, intracerebral hemorrhage, including hypertensive, subdural, and subarachnoid hemorrhage, meningoencephalitis, and brain trauma.
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Keywords
- Status Epilepticus
- Acute Stroke
- Mean Arterial Blood Pressure
- Cerebral Amyloid Angiopathy
- Convulsive Status Epilepticus
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.
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Crino, P.B. (2002). Seizures in Acute Neurological Disorders. In: Delanty, N. (eds) Seizures. Current Clinical Neurology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-59259-094-0_3
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DOI: https://doi.org/10.1007/978-1-59259-094-0_3
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