Seizures In Emergency Department Research Articles

Study of Clinical Profile, Management and Outcome of Patients Presented with Seizures in Emergency Medicine Department

Background: Seizures are sudden, uncontrolled electrical disturbances in the brain that causes widerange of symptoms. Predominant causes are CNS infection, trauma, space occupying lesion, cerebrovascular accidentsetc. The goal of the emergency clinician is to differentiate seizures from mimics andidentify reversible causes.Management focuses on identifying reversible causes such as hypoxia, hypoglycemia and initiating pharmacological treatment. Aim: The aim is to study different variablesrelated to clinical profile, management and outcome of the patients presenting with seizures inEmergency Department (ED).Material & Methods: We conducted a prospective observational studyon 200 patients who presented with seizures in the emergency medicine department according toinclusion and exclusion criteria from September 2020-October 2021. In all patients of our study, primary and secondary surveys along with immediate resuscitation were done. A brief history, clinical examination and all necessary hematological and radiological investigations were done. Patients weretreated accordingly and followed-up until discharge or death.Results: Out of 200, 73% patients weremales and 27% were females. Mean age of study population was 49.3 years. Idiopathic(26%) was theleading cause followed by alcohol withdrawal seizure(20%) and cardio-vascular accident (13%) withgeneralized tonic clonic seizures (GTCS) being the commonest type (67%). Majority of patients(95%) were treated with anti-epileptic drugs (AEDs).Conclusion:Along with immediate primaryresuscitation, early identification, prevention of recurrence and treating the cause forms the basis ofmanagement of seizures in emergency department. Key Words: Seizure, Management, Idiopathic, Emergency department

E029 Intracranial haemorrhage in scleroderma renal crisis; an unusual presentation

Abstract Background/Aims Scleroderma renal crisis is a life-threatening complication of systemic sclerosis (SSc), which typically occurs in the first 5 years after disease onset. Several risk factors for development of renal crisis are well recognised, including diffuse skin involvement, presence of RNA polymerase 3 antibodies and preceding use of corticosteroids. Methods A 66 year old female 6 years post diagnosis of stable diffuse systemic sclerosis/ polymyositis overlap (PM Scl 100 positive) presented to her GP with a 1 week history of fatigue. She had been seen 2 months earlier by her rheumatologist with stable, mild skin involvement. She had no preceding history of hypertension or other significant co-morbidity. A month earlier she received antibiotics for a chest infection from which she made a slow but complete recovery. She was found to have shingles and started a course of oral acyclovir. Blood tests revealed acute kidney injury stage 3 (eGFR 10 from baseline 70). However, she deteriorated overnight, waking with headache and disturbed colour vision. This quickly deteriorated to bilateral blindness precipitating admission to the emergency department (ED). On arrival she was conscious but severely hypertensive with a BP of 240/105. She received ramipril, amlodipine and a GTN infusion with limited efficacy. CT head (CTH) showed a left occipitoparietal bleed. She then experienced a seizure in ED, which was terminated with lorazepam. She was intubated in the post ictal phase. Repeat CTH following the seizure showed a right frontal bleed extending into the subarachnoid space. Repeat CTH at 48 hours showed progression of the right frontal and left parieto-occipital intracerebral haemorrhages, with evidence of posterior reversible encephalopathy syndrome. Lumbar puncture was normal (VZV negative). Treatment was commenced with intravenous hydralazine. On day 2 of admission she required haemofiltration and subsequently regular renal dialysis. Results SSc was diagnosed in 2016, since when her main issue had been severe Raynaud’s phenomenon for which she took sildenafil. Her muscle disease had only ever manifested as a modestly raised CPK, which settled with a brief course of low dose prednisolone at diagnosis. She has never required DMARDs. She had mild reflux symptoms. Skin tightening was noted distally over her fingers, forearms, lower legs and feet. Annual echocardiography showed nothing to suggest developing pulmonary arterial hypertension. With supportive management she has made a remarkable neurological recovery and has returned to her pre-morbid level of function. She remains dialysis dependent at 4 months. Conclusion This lady lacked a single recognised risk factor for developing a renal crisis, and this occurred quite unexpectedly following a reassuring clinic visit just 2 months prior to presentation. As rheumatologists we must remain vigilant for features of a renal crisis and avoid being falsely reassured by a low risk profile. Disclosure L. Parker: None. N. Buchanan: None. E.L. Williams: None.

Seizure in emergency department: Finding the Zebra among the Horses

Aortic dissection is a life threatening emergency that mandates early and precise diagnosis. Chest pain is the most common presenting complaint and it is classically described as sharp excruciating and having tearing or ripping quality with location migrating as the dissection extends along the aorta. The frequency of neurological involvement is reported as between 17-40 %. Seizure as exclusive manifestation of aortic dissection is very uncommon and only two such cases have been reported till date in literature. We report a case of type A aortic dissection who presented with seizures to our Emergency Department (ED).

Why Should I Take My Medicine? A Review Of ED Visits For Seizures.

Study hypothesis 
 The costs of anti-epileptic medication (AED) and poor care coordination result in increased Emergency Department (ED) visits for seizure events and produce both direct and indirect economic burdens on patients with frequent seizures. 
 
 Methods 
 A retrospective chart review study of ED visits with chief concern of seizure from two hospitals over a two-year period was performed; resulting in 152 visits recorded in this study. Data collected included demographic information, relevant seizure or past medical history (PMH), diagnostics performed in the ED, and the admission status of the patient along with the total charges per encounter. Data was analyzed descriptively and with logistic regression analysis. 
 
 Results 
 The results yielded by this study were generally in-line with the results of similar studies, indicating a higher relative rate of ED seizure visits for males, people of Black race, and infant and toddler populations. A high proportion of Medicaid/Medicare coverage and indiscernible employment status for most patients were also noted. Observed differences in average cost among patients with and without epilepsy and male versus female patients were not shown to be statistically significant. However, the increased likelihood of admission with increasing age was shown to be significant with an average age difference between admitted and discharged populations of approximately 10 years (p= 0.003). 
 
 Conclusions 
 The data provided here is not sufficient to examine the complex relationship between seizures, epilepsy, and costs among various other patient factors. Further study is necessary to minimize direct and indirect costs of seizures. 
 
 Acknowledgments 
 This project was funded, in part, with support from the Indiana Clinical and Translational Sciences Institute funded, in part by UL1TR002529 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Atención de pacientes adultos con crisis epilépticas en servicios de urgencias (Registro ACESUR). Diferencias en función de la edad ≥ 75 años

ObjectivesTo determine whether there are differences in the profile and in the care of adult patients with epileptic seizures in emergency department according to age ≥75 years, and if this is independently associated with results in the emergency department and 30 days after discharge. Material and methodsACESUR is a multicentre, prospective, observational cohort multipurpose register that was carried out in 2017. The distribution of the variables corresponding to the clinical presentation and care according to age ≥75 years were compared. Subsequently, logistic regression models were performed with the objective of evaluating the effect of age ≥75 years on the outcome variables. ResultsA total of 541 (81.5%) cases younger than 75 years were analysed compared to 123 adult patients (18.5%) of ≥75 years or more. In the group of long-lived it was observed significantly greater probability of dependence, co-morbidity, polypharmacy, a previous visit to the hospital emergency department, arrived by ambulance, first seizures and a symptomatic aetiopathogenic classification. In the multivariate analysis, after adjusting for the above variables, it is observed that age >75 years is associated independently with a higher incidence of specific supplementary tests (OR: 2.31; 95% CI: 1.21-4.44), but not pharmacological intervention (OR: 1.63; 95% CI: 0.96-2.80), or hospitalisation or extended stay in emergency departments (OR: 1.56; 95% CI: 0.94-2.59). On adjusting for all previous variables, age >75 years is associated with lower incidence of adverse events at 30 days (OR: 0.43; 95% CI: 0.25-0.77). ConclusionsIn the ACESUR Registry, differences in clinical presentation and in the care of patients with seizures in emergency departments were identified when comparing those patients >75 years with those <75 years. Age ≥75 years is not independently associated with a higher incidence of intervention in emergency departments, or with more adverse outcomes at 30 days after discharge.

Características y manejo de las crisis epilépticas en urgencias y su correlación diagnóstica tras el ingreso

Patients with seizures are common in the emergency department (ED), yet little is known regarding the management of these patients. This study was performed to define the demographic characteristics of patients with seizure disorders in the ED patient population and to determine final disposition, diagnostic and therapeutic activities, and to evaluate the concordance between provisional and definitive diagnosis. We recorded prospectively all patients which were diagnosed of seizure in ED of Hospital Clínico of Zaragoza between November 1th and April 30th. Chart review was used to gather definitive diagnosis regarding these patients. Of the 54,022 patients who presented to the ED during the study period, 137 (0.36%) had complains related to seizures. Sixty one (44%) of these patients were admitted to the hospital. New-onset seizures were thought to be present in 60% of patients. Blood work was abnormal in 12% of patients and 48% of patients had pathological findings in neuroimaging study. False positive diagnosis was present in 33% of patients. The most important trigger of seizures in epileptic patients was tapped suddenly the antiepileptic drug treatment. We found a false positive diagnosis in 33% of patients, and the most important confounding pathology was sincope and stroke. High percentaje of pathological findings in neuroimaging studies were found. Electroencefalographic and toxicological studies were performed less than is recommended.

Are Ambient Spring and Summer Ozone Levels Associated with Daily Emergency Department Seizure Visits?

Are Ambient Spring and Summer Ozone Levels Associated with Daily Emergency Department Seizure Visits?