Since its debut in the 1960s, the broad use and availability of benzodiazepines has mirrored the
increased incidence of overdose cases. Due to its non-specic presentation, there is often a delay in
diagnosis. We report a case of Benzodiazepine toxicity in a 70-year-old man who presented to us in a comatose state. He was
evaluated at another hospital initially and was intubated in view of his low Glasgow Coma scale. A CT brain plain study was
done suspecting a basilar artery thrombus and he was referred to us for Neuro-Interventional procedures. As radiological,
laboratory and electrophysiological investigations were unremarkable a provisional diagnosis of drug intoxication was made
after patient medication review and a trial of Flumazenil was given, after which the patient had improved dramatically.
Flumazenil is not routinely used due to fears of withdrawal seizures and its high cost. It also has no effect on reversing sedation
caused by barbiturates, ethanol, or opioids. The antidote has a favorable risk-benet ratio when dosed appropriately and can
be a helpful diagnostic tool after ruling out the more common causes of acute sensorium loss as demonstrated by this case
report.
The incidence of middle cerebral artery aneurysm rupture in pregnancy is rare. Rupture of an intracranial aneurysm is the most common cause of subarachnoid hemorrhage in pregnancy and during puerperium. Intracranial aneurysm rupture during pregnancy is disastrous for the mother as well as the fetus. We report a case of a dissecting left middle cerebral artery aneurysm in a 25-year-old woman, G2P1L1, at 18 weeks of gestation, who presented with a 1-day history of giddiness, slurring of speech, and facial deviation to the left.
Management of refractory status epilepticus is challenging for a neurointensivist consequent to systemic complexities associated with various drugs and modalities involved in its treatment. We report one such case that manifested with multiple signs of malignant hyperthermia following use of isoflurane to control seizures. However, the delayed and random occurrence of the signs and negative genetic test report raises doubts regarding the final diagnosis. Delayed presentation of malignant hyperthermia has been reported earlier. Unavailability of dantrolene sodium handily is a major hurdle in treating such cases. We enumerate management of the patient in our intensive care unit.
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