A case with hyperammonemic encephalopathy triggered by single dose valproate

Çiftçi, Şeyma; Güler, Ayşe; Deveci, Emrah Emre; Çelebisoy, Neşe; Yüceyar, Nur

doi:10.1007/s10072-016-2673-z

Cited by 7 publications

(4 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In most cases, no correlation was found between VPA blood level and ammoniac level, and VHE has been observed with therapeutic doses and normal blood levels of VPA (2). Two case presentations in Turkey reported VHE with the VPA blood level being in the normal range (8) or even after administering a single dose of VPA (9). In our case as well, the ammoniac level dramatically rose in the acute phase while the VPA blood level was in normal range.…”

Section: Letter To the Editorsupporting

confidence: 64%

Valproic acid-induced Hyperammonemic Encephalopathy

Hocaoglu¹,

Özsoy²,

Bulut³

et al. 2020

Dusunen Adam

View full text Add to dashboard Cite

Section: Letter To the Editorsupporting

confidence: 64%

Valproic acid-induced Hyperammonemic Encephalopathy

Hocaoglu¹,

Özsoy²,

Bulut³

et al. 2020

Dusunen Adam

View full text Add to dashboard Cite

“…Involvement of the thalami was present in cases 1 and 2. An unusual finding was involvement of the caudate nucleus in case 1: to the best of our knowledge, such a finding was described uniquely by Cifcti et al [10] in a case of valproate toxicity. We observed no involvement of white matter.…”

Section: Discussionmentioning

confidence: 52%

“…The most striking MRI features described in acute hyperammonemic encephalopathy are bilateral symmetrical cortical signal abnormalities in the insula and cingulate gyrus [9][10][11][12][13][14][15], most often showing cytotoxic edema [10,[12][13][14][15]. Involvement of frontal, temporal and parietal cortices, with various degrees of extension and symmetry, is almost always reported [10][11][12][13][14][15][16], along with sparing of occipital and peri-rolandic cortices [11,12,14,15]. Signal abnormalities in the thalami, once thought uncommon, are also a frequent finding [11,13,16].…”

Section: Discussionmentioning

confidence: 99%

MRI Findings in Acute Hyperammonemic Encephalopathy: Three Cases of Different Etiologies

Reis

Coolen

Lolli

2020

Journal of the Belgian Society of Radiology

View full text Add to dashboard Cite

Acute hyperammonemic encephalopathy is a rare but life-threatening condition that might complicate liver disease as well as non-hepatic conditions. It can lead to coma and death, secondary to brain edema and intracranial hypertension. We present three cases of acute hyperammonemic encephalopathy of different etiologies and the observed brain MRI findings. Symmetrical extensive cortical signal abnormalities, typically involving the insular and cingulate cortices, often showing restricted diffusion, are commonly described. These specific imaging features should be recognized by the radiologist since prompt treatment of the condition is paramount.

show abstract

“…Manual search of reference lists and gray literature did not identify additional studies. After screening and assessing for eligibility, 240 studies were included with the remaining articles being excluded for meeting the exclusion criteria 6,7,12–245 . Among the excluded 350 articles, 37 were literature reviews, 5 were pharmacokinetically related, 41 were VPA overdose related, and 267 articles were unable to clearly answer our objectives listed.…”

Section: Resultsmentioning

confidence: 99%

Valproic Acid–Associated Hyperammonemia

Wong

Fan

Wan

et al. 2023

J Clin Psychopharmacol

View full text Add to dashboard Cite

BackgroundHyperammonemia is an adverse effect that poses clinical uncertainty around valproic acid (VPA) use. The prevalence of symptomatic and asymptomatic hyperammonemia and its relationship to VPA concentration is not well established. There is also no clear guidance regarding its management. This results in variability in the monitoring and treatment of VPA–induced hyperammonemia. To inform clinical practice, this systematic review aims to summarize evidence available around VPA-associated hyperammonemia and its prevalence, clinical outcomes, and management.MethodsAn electronic search was performed through Ovid MEDLINE, Ovid Embase, Web of Science, and PsycINFO using search terms that identified hyperammonemia in patients receiving VPA. Two reviewers independently performed primary title and abstract screening with a third reviewer resolving conflicting screening results. This process was repeated during the full-text review process.ResultsA total of 240 articles were included. Prevalence of asymptomatic hyperammonemia (5%–73%) was higher than symptomatic hyperammonemia (0.7%–22.2%) and occurred within the therapeutic range of VPA serum concentration. Various risk factors were identified, including concomitant medications, liver injury, and defects in carnitine metabolism. With VPA discontinued, most symptomatic patients returned to baseline mental status with normalized ammonia level. There was insufficient data to support routine monitoring of ammonia level for VPA-associated hyperammonemia.ConclusionsValproic acid–associated hyperammonemia is a common adverse effect that may occur within therapeutic range of VPA. Further studies are required to determine the benefit of routine ammonia level monitoring and to guide the management of VPA-associated hyperammonemia.

show abstract

A case with hyperammonemic encephalopathy triggered by single dose valproate

Cited by 7 publications

References 5 publications

Valproic acid-induced Hyperammonemic Encephalopathy

Valproic acid-induced Hyperammonemic Encephalopathy

MRI Findings in Acute Hyperammonemic Encephalopathy: Three Cases of Different Etiologies

Valproic Acid–Associated Hyperammonemia

Contact Info

Product

Resources

About