RESUMEN
Background Status epilepticus (SE) is a common neurologic emergency with high rates of mortality and morbidity. Objective To analyze the clinical characteristics, causes, management, and outcomes of patients with SE in a tertiary care hospital in Morocco. Methods A retrospective study was conducted from January 2019 to December 2021, including all patients admitted to the medico-surgical general intensive care unit (ICU) with a diagnosis of SE. We recorded demographic characteristics, SE clinical history, management, causes, and discharge outcomes. Results Overall, 82 patients with SE were included, the median age was 39.5 years (18-95), 61% of the patients were male, the majority of semiology was convulsive SE (93%, N: 77), epilepsy of unknown cause was the most common diagnosis (41.2%, N: 34), and the most known etiology was acute/subacute cerebrovascular events (12 patients, 14.4%). All patients received benzodiazepines, 96.4% of them received phenobarbital as a second line of treatment, 65 patients required anesthesia, 52 patients developed one complication at least - the most common complication being systemic infection, and the mortality rate was noted to be 38% among patients with SE (N: 31). In this study, the factors associated with mortality were ischemic stroke (as an etiology of SE (p=0.048), history of epilepsy (p=0.005), poor therapeutic adherence (p=0.001), cardiovascular complications, presence of multiple complications (p=0.0001), pneumonia (p=0.0001), and the recurrence of SE (p=0.050). Conclusions We provide a single-center retrospective analysis of admissions in SE and note that mortality among SE patients is high in our settings. Improving prehospital emergency care and implementing elective ICU admission for patients at high risk could improve the mortality rate.
RESUMEN
Cresol is a phenol derivative used as a disinfectant that may cause gastrointestinal corrosive injury, central nervous system, cardiovascular disturbances, renal, and hepatic injury following intoxication. We present a case of a female patient who was admitted to the emergency department after ingesting an unknown amount of cresol; she was admitted with tachypnea, shortness of breath with low oxygen level in the blood. She did not develop hepatic or renal dysfunction. The gastrointestinal endoscopy was performed and showed esophagus and gastric erosins only. The patient was sedated and ventilated for 7 days. After receiving supportive intensive care, the patient recovered and was sent for psychiatric evaluation. Cresol intoxication can be fatal, and cause a respiratory failure with an acute respiratory distress syndrome (ARDS), hepatic, and renal injury. This shows the importance of intensive care in the management of cresol poisoning.
Asunto(s)
Neoplasias Cardíacas/complicaciones , Válvula Mitral/patología , Mixoma/complicaciones , Edema Pulmonar/etiología , Enfermedad Aguda , Anciano , Ecocardiografía , Circulación Extracorporea , Femenino , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/cirugía , Humanos , Válvula Mitral/cirugía , Mixoma/diagnóstico por imagen , Mixoma/cirugía , Edema Pulmonar/patologíaAsunto(s)
Cistitis/complicaciones , Diabetes Mellitus Tipo 2/complicaciones , Enfisema/complicaciones , Choque Séptico/etiología , Cistitis/etiología , Enfisema/etiología , Femenino , Humanos , Persona de Mediana Edad , Rotura Espontánea , Tomografía Computarizada por Rayos X , Vejiga Urinaria/patologíaAsunto(s)
Enfermedades Cerebelosas/etiología , Drenaje/efectos adversos , Hematoma Subdural Crónico/cirugía , Hemorragias Intracraneales/etiología , Anciano , Enfermedades Cerebelosas/diagnóstico , Enfermedades Cerebelosas/patología , Drenaje/métodos , Humanos , Hemorragias Intracraneales/diagnóstico , Hemorragias Intracraneales/patología , Masculino , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/patologíaAsunto(s)
Traumatismos Craneocerebrales/terapia , Intubación Intratraqueal/efectos adversos , Fístula Traqueoesofágica/etiología , Adulto , Traumatismos Craneocerebrales/fisiopatología , Escala de Coma de Glasgow , Humanos , Intubación Intratraqueal/métodos , Masculino , Factores de Tiempo , Fístula Traqueoesofágica/patologíaAsunto(s)
Hemorragia Subaracnoidea/complicaciones , Vasoespasmo Intracraneal/etiología , Anciano , Resultado Fatal , Femenino , Humanos , Índice de Severidad de la Enfermedad , Hemorragia Subaracnoidea/diagnóstico , Hemorragia Subaracnoidea/patología , Vasoespasmo Intracraneal/diagnóstico , Vasoespasmo Intracraneal/patologíaAsunto(s)
Hematoma/diagnóstico , Trombosis Intracraneal/diagnóstico , Hemorragia Subaracnoidea/diagnóstico , Trombosis de la Vena/diagnóstico , Adulto , Anticoagulantes/uso terapéutico , Angiografía Cerebral/métodos , Femenino , Hematoma/patología , Humanos , Trombosis Intracraneal/tratamiento farmacológico , Trombosis Intracraneal/patología , Hemorragia Subaracnoidea/patología , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/patologíaAsunto(s)
Antibacterianos/administración & dosificación , Infección Hospitalaria/epidemiología , Unidades de Cuidados Intensivos , Neumonía Bacteriana/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Infección Hospitalaria/tratamiento farmacológico , Infección Hospitalaria/microbiología , Farmacorresistencia Bacteriana , Femenino , Bacterias Gramnegativas/aislamiento & purificación , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Marruecos/epidemiología , Neumonía Bacteriana/tratamiento farmacológico , Neumonía Bacteriana/microbiología , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Adulto JovenAsunto(s)
Anemia/epidemiología , Embolia Grasa/terapia , Fracturas Óseas/complicaciones , Trombocitopenia/epidemiología , Adulto , Anemia/etiología , Embolia Grasa/etiología , Embolia Grasa/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Síndrome , Trombocitopenia/etiología , Factores de Tiempo , Adulto JovenAsunto(s)
Neumotórax/etiología , Complicaciones Posoperatorias/etiología , Parálisis de los Pliegues Vocales/etiología , Biopsia , Femenino , Humanos , Neoplasias Laríngeas/cirugía , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/secundario , Persona de Mediana Edad , Neumotórax/diagnóstico por imagen , Complicaciones Posoperatorias/diagnóstico por imagen , Radiografía , Rotura Espontánea , Enfisema Subcutáneo/etiología , TraqueotomíaAsunto(s)
Enfermedades de la Mama/complicaciones , Intertrigo/complicaciones , Mucormicosis/complicaciones , Enfermedades de la Mama/diagnóstico , Diagnóstico Tardío , Diabetes Mellitus Tipo 2/complicaciones , Errores Diagnósticos , Resultado Fatal , Femenino , Humanos , Intertrigo/diagnóstico , Persona de Mediana Edad , Mucormicosis/diagnósticoAsunto(s)
Seno Frontal , Mucocele/diagnóstico , Enfermedades Orbitales/diagnóstico , Enfermedades de los Senos Paranasales/diagnóstico , Anciano , Diplopía/etiología , Diplopía/cirugía , Exoftalmia/etiología , Exoftalmia/cirugía , Femenino , Seno Frontal/cirugía , Humanos , Mucocele/cirugía , Enfermedades Orbitales/cirugía , Osteólisis/diagnóstico , Osteólisis/cirugía , Enfermedades de los Senos Paranasales/cirugía , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Thrombophlebitis of the cavernous sinus is a rare but serious disease that most often affects young adults and children. It is associated with significant morbidity or mortality and is often related to local infections of the head. The diagnosis is based on clinical findings and is confirmed by imaging. CASE REPORT: We report the case of a 17-year-old male with a history of recurrent sinusitis, who presented general signs of infection, orbital symptoms, and meningeal involvement. CT and MRI showed thrombosis of the cavernous sinus associated with cerebral ischemic damage. The therapeutic management included empiric antibiotic therapy, drainage of an orbital collection, and anticoagulation. The patient died later secondary to septic shock. CONCLUSIONS: Although thrombophlebitis of the cavernous sinus is increasingly rare, it remains a lethal complication of sinusitis, and mortality is still high. The course of this disease can be dramatic due to infectious or vascular neurological complications. Early diagnosis and appropriate treatment are crucial.