An Unusual Cause of Frequent, Sudden, Transient, Unexplained Falls and New-Onset Status Epilepticus: Case Report and Mini-Review

Abstract

We report a 14-year old adolescent Caucasian female, who presented with frequent, sudden, transient, and unexplained falls leading to multiple serious injuries to her head and extremities requiring several visits to the emergency department. She was evaluated numerous times and imaging studies, echocardiogram, electrocardiogram, and electroencephalogram studies were all normal. She eventually presented to outside emergency department with dystonic posturing and status epilepticus and was transferred to our pediatric intensive care unit for further management. She was diagnosed with an uncommon, underrecognized and underdiagnosed condition. To our knowledge there is no such previous report in a pediatric patient.

The use of dexmedetomidine in the emergency department: A systematic review

“…Study designs included 11 RCTs, 22,32–41 13 cohort studies and other nonrandomized studies, 19–21,23,42–50 and 11 case series and case reports 12,51–60 . Six of the included studies were conference abstracts 20,21,40,47,50,56 .…”

“…Other indications, including facilitation of mechanical ventilation or NIPPV and prevention of ketamine‐associated emergence delirium or ketamine‐associated adverse effects, were uncommonly reported, significantly limiting any high‐level conclusions. Notably, use of DEX in intubated ED patients was reported in only one cohort study 19 and one case report 57 …”

“…A key finding of this review is that some of the most common and important indications for DEX in the ED are clearly underinvestigated. It is particularly noteworthy that there is very little evidence describing the use of DEX to facilitate invasive or noninvasive mechanical ventilation, which was reported in only one cohort study 19 and two case reports 57,59 . As ED boarding times for critically ill patients continue to increase, this will be a critical area to address with future research.…”

“…Notably, use of DEX in intubated ED patients was reported in only one cohort study 19 and one case report. 57 Adverse events associated with DEX Eight RCTs reported information regarding adverse events associated with DEX. Three trials identified higher rates of adverse events with DEX than with the various pharmacologic comparators.…”

“…Study designs included 11 RCTs, 22,[32][33][34][35][36][37][38][39][40][41] 13 cohort studies and other nonrandomized studies, [19][20][21]23,[42][43][44][45][46][47][48][49][50] and 11 case series and case reports. 12,[51][52][53][54][55][56][57][58][59][60] Six of the included studies were conference abstracts. 20,21,40,47,50,56 Dates of publication ranged from 2010 to Each of the 11 case reports and case series were judged to be either high risk of bias or had some concerns.…”