Status epilepticus-induced hyperemia and brain tissue hypoxia after cardiac arrest.

OBJECTIVE

To report changes of cerebral blood flow and metabolism associated with status epilepticus after cardiac arrest.

DESIGN

Case report.

SETTING

Neurological intensive care unit in a university hospital.

PATIENT: An 85-year-old man resuscitated from out-of-hospital cardiac arrest underwent brain multimodality monitoring and treatment with therapeutic hypothermia.

MAIN OUTCOME MEASURES: Changes of cerebral blood flow and metabolism.

RESULTS

Repetitive electrographic seizure activity detected at the start of monitoring was associated with dramatic reductions in brain tissue oxygen tension and striking surges in cerebral blood flow and brain temperature. Intravenous lorazepam and levetiracetam administration resulted in immediate cessation of the seizures and these associated derangements. The lactate to pyruvate ratio was initially elevated and trended down after administration of anticonvulsants.

CONCLUSION

Brain multimodality monitoring is a feasible method for evaluating secondary brain injury associated with seizure activity after cardiac arrest.