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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We present a case of thrombotic thrombocytopenic purpura (TTP) in a human immunodeficiency virus (HIV)-positive woman with altered mental status. Altered mental status with thrombocytopenia may be due to many causes, including consumptive coagulopathy, systemic lupus erythematosis, infection, and as side effects of commonly used anti-seizure medications. Of these, platelet transfusion is ineffective or specifically contraindicated in the consumptive coagulopathies, including TTP. TTP should be considered in all patients with altered mental status or neurologic dysfunction, thrombocytopenia, and hemolytic anemia to prevent morbidity and mortality.
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PMID:Thrombocytopenia and altered mental status in an HIV-positive woman. 1211 46

Altered mental status is a common occurrence in children with acute critical illness. The causes of non-traumatic coma are diverse ranging from neurological to systemic causes. Early appropriate supportive care is essential to avoid preventable secondary insults and optimize the neurological outcome. Evaluation and stabilization of the patient's airway, breathing and circulation (ABCs) must proceed simultaneously with assessments of the depth of coma and the presence of raised intracranial pressure (ICP). Any rapidly correctable cause of coma must be immediately corrected. Most patients with non-traumatic encephalopathies have raised ICP, although papilledema may be absent and the CT scan may be normal if ICP elevation occurs acutely. The most important early treatment for raised ICP is controlled intubation and ventilation followed by osmotherapy. Early control of seizures, including non-convulsive seizures is important. Urgent imaging is indicated in most cases particularly in the presence of afebrile coma, focal signs or papilledema. Following stabilization, isotonic fluids are administered, aiming for euvolemia and euglycaemia. Ventilation should aim for the lower end of eucapnia to avoid causing cerebral ischemia. Surgical options should be explored and, in refractory intracranial hypertension, barbiturates and mild hypothermia may have a role.
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PMID:Emergency and intensive care management of a comatose patient with intracranial hypertension, current concepts. 1673 62

Altered mental status can have many causes, some of which are life threatening, especially in children. In addition to the usual central nervous system and metabolic causes, such as meningitis, encephalitis, seizure, electrolyte imbalance, and inborn errors of metabolism, some less common causes of altered mental status, which if not diagnosed and managed rapidly, can have poor consequences. We present a case of a child with a life-threatening unusual cause of altered mental status, a mesenteric hernia with hypovolemic shock. The hernia was reduced successfully at laparotomy. The postoperative course was uneventful.
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PMID:An unusual cause of pediatric altered mental status: a mesenteric hernia. 1975 98

The differential diagnosis and empiric management of altered mental status and seizures often overlap. Altered mental status may accompany seizures or simply be the manifestation of a postictal state. This article provides an overview of the numerous causes of altered mental status and seizures: metabolic, toxic, malignant, infectious, and endocrine causes. The article focuses on those agents that should prompt the emergency physician to initiate unique therapy to abate the seizure and correct the underlying cause.
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PMID:Seizures as a cause of altered mental status. 2070 42

Thrombotic thrombocytopenic purpura (TTP) is a syndrome with numerous neurological manifestations including altered mental status and seizures. However, status epilepticus (SE) has rarely been reported in this condition. Signs may be transient or fluctuate; however, permanent deficits do occur. Its prognosis was once considered uniformly poor, with a high mortality rate. Since the introduction of plasma infusions and exchanges, the prognosis of the disease has improved dramatically; remissions now occur in 80-90% of patients. Altered mental status in TTP often resolves with plasmapheresis. Likewise, we successfully treated a patient with thrombotic thrombocytopenic purpura (TTP) with pronounced clinical effects of status epilepticus with plasmapheresis and steroid treatment.
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PMID:Treatment of status epilepticus with plasmapheresis in a patient with thrombotic thrombocytopenic purpura. 2184 73

Tacrolimus-associated posterior reversible encephalopathy syndrome (PRES) is a potential complication of allogeneic stem cell transplant (SCT). Due to the paucity of information on the management of PRES in SCT patients receiving tacrolimus, more information is needed on trends associated with the incidence of PRES and to characterize its management. A retrospective review was conducted of patients receiving tacrolimus for prevention of graft versus host disease (GVHD) after allogeneic SCT who developed PRES from September 2008 to July 2011. Nineteen patients were identified. Altered mental status, seizures, and visual abnormalities were experienced by 78.9%, 52.6%, and 31.5% of the patients, respectively, at time of PRES onset. Compared with baseline, patients with PRES were likely to have an increase in mean arterial pressure (P < 0.0001) and serum creatinine. Elevated tacrolimus levels and hypomagnesemia were not observed with PRES onset. Tacrolimus was managed in three general strategy groups: not held, held then continued, and switched to another agent. Survival was defined as survival to discharge from PRES hospitalization. When tacrolimus was not held, held then continued, or switched to another agent, 40% (2 of 5), 40% (4/10), and 50% (2/4) survived to discharge, respectively. PRES was associated with high blood pressure and adequate blood pressure control should be part of its management. No management strategy pertaining to tacrolimus usage appeared more beneficial over another.
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PMID:Tacrolimus-associated posterior reversible encephalopathy syndrome in hematopoietic allogeneic stem cell transplantation. 2346 Mar 78