Case-Based Modules > Case 14 > Stage 4

Another 4mg of IV lorazepam is given. At first, the convulsions abate within two minutes of administration. The patient is somnolent. However, his generalized convulsions begin again. At this point, your neurology colleague arrives, and helps to direct continued management of the patient's generalized convulsive status epilepticus. They give a second-line agent (IV levetiracetam 4500mg here) and end up needing to have the patient intubated and sedated with propofol gtt. The patient's convulsions stop. The patient is admitted to the NCCU.

The patient is stable upon arrival to the NCCU. Due to concern about this patient's acute post-traumatic seizures, we send him to the scanner for a stability scan. There's now subtle signs of mild diffuse cerebral edema. Because we no longer have an exam and are worried about high ICPs, you place an intraparenchymal ICP monitor, which reveals ICPs in excess of 25mmHg. You're able to manage his intracranial hypertension with sedation and hyperosmolar therapies. The patient does get connected to cEEG. The neurointensivist starts a second ASM for him. After a lot of work, he is weaned off sedation over the next few days. He's extubated on day 6 of his ICU admission. He's ultimately discharged from the floor to inpatient rehab on day 12 of admission.

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