Generalized status epilepticus associated with massive pulmonary aspiration and transient central diabetes insipidus: case report

Abstract

-Status epilepticus causes significant morbidity and mortality. A case of generalized status epilepticus followed by massive pulmonary aspiration, acute respiratory failure and transient central diabetes insipidus is presented. Seizures were promptly controlled, but the patient required mechanical ventilation and correction of polyuria with desmopressin acetate. During hospitalization mental status improved, diabetes insipidus spontaneously remitted and he was discharged without neurologic sequelae. The clinical and pathophysiological features of this case are discussed.KEY WORDS: status epilepticus, central diabetes insipidus, neurohypophysis. Estado de mal epiléptico associado a aspiração pulmonar maciça e diabetes insípido central transitório: relato de casoRESUMO -O estado de mal epiléptico causa morbidade e mortalidade significativas. Relatamos um caso de mal convulsivo generalizado, associado à aspiração pulmonar maciça, insuficiência respiratória aguda e diabetes insípido central transitório. As convulsões foram rapidamente controladas, porém o paciente necessitou de ventilação mecânica e correção da poliúria com acetato de desmopressina. Durante a hospitalização o nível de consciência normalizou-se, houve remissão espontânea do diabetes insípido e o paciente recebeu alta sem seqüelas neurológicas. São discutidos aspectos clínicos e patogênicos desta condição clínica. PALAVRAS-CHAVE: estado de mal epiléptico, diabetes insípido central, neuro-hipófise.The term status epilepticus (SE) refers to the occurrence of a single unremitting seizure or frequent clinical seizures without an interictal return to normal consciousness 1,2 . A range of mortality rates between one and fifty percent has been reported in different study groups 3 . Acute process that cause SE include metabolic disturbances, central nervous system infection, stroke, head trauma, drug toxicity, and hypoxia 4 . Seizures in this last category are associated with a higher mortality, especially in older patients 5 .Central diabetes insipidus is caused by failure to normally synthesize or secrete vasopressin. It is a polyuric disorder characterized by high rates of electrolyte-free water excretion. Lack