Neurological deficits after brain surgery are not uncommon, and correct and prompt differential diagnosis is essential to initiate appropriate treatment. We describe a patient suffering from loss of consciousness due to hyperammonemia, following valproic acid treatment after surgery for an unruptured cerebral aneurysm. A 57-year-old female patient underwent successful aneurysmal neck clipping to correct an unruptured aneurysm. Her postoperative course was good, and she received anti-epileptic therapy (valproic acid) and a soft diet. Within a few days the patient experienced mental deterioration. Her serum valproic acid reached toxic levels (149.40 mg/L), and serum ammonia was fifteen times the upper normal limit (553 mmol/L; normal range, 9-33 mmol/L). After discontinuation of valproic acid and with conservative treatment, the patient recovered without any complications. Valproate-induced hyperammonemic encephalopathy is an unusual but serious neurosurgical complication, and should not be disregarded as a possible cause of neurological deficits after neurovascular surgery. Early diagnosis is crucial, as discontinuation of valproic acid therapy can prevent serious complications, including death.
March 2010 through March 2012. As the largest medical complex in the world, the Texas Medical Center is located in Houston, where the member institutions of the Texas Medical Center such as M.D. Anderson Cancer Center, one of the largest cancer centers in the world, Memorial Hermann Hospital and Baylor College of Medicine are known throughout the world. As an instrumental instructor at Baylor College of Medicine, I had tremendous experiences under the supervision of Professor Daniel H. Kim. Dr. Daniel Kim is a professor in the Department of Neurosurgery at Baylor College of Medicine where he also serves as the Director of Spinal Neurosurgery and Reconstructive Peripheral Nerve Surgery. Dr. Kim is also the Chair of the Spine Center of Neurosurgery and Orthopedic Surgery and leads a joint conference for discussion of patient treatment. Not only patients from the U.S, also thousands of international patients each year visit the Texas Medical Center for patient care services, recognizing that the quality of the care for the scope of the health services are unsurpassed anywhere in the world. The Chairman of the
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