Abstracts

Rationale: Status epilepticus is at the most severe end of the spectrum of seizures in man. Prolonged seizure activity places a huge metabolic demand on the area of brain involved, albeit usually with reversible levels of dysfunction. We present 3 cases where the intense metabolic demand on the cortex resulted in a severe unihemispheric hypoxic-ischaemic and irreversible injury.  Methods: Case series of 3 patients Results: Case 1: A 25 year old with a history of an AVM associated left frontal haemorrhage at 9 years old and subsequent focal epilepsy  was found in prolonged convulsive status epilepticus at the age of 23 years. After resuscitation he was noted to have persistent left-sided weakness. MRI showed restricted diffusion diffusely throughout the right hemisphere. He has residual dense left hemiparesis and cognitive dysfunction.Case 2: A 39 year old healthy woman was found unresponsive in a postictal state. Clinical and electrographic seizures were controlled with anti-epileptic medication.  CSF and brain biopsy supported the diagnosis of viral encephalitis.  Brain biopsy also showed grey matter necrosis. MR brain showed diffuse restricted diffusion in the right hemisphere.  She has residual dense left hemiparesis and cognitive dysfunction.Case 3: A 20 year old man had status epilepticus at the age of 11 months. CT imaging at the time showed swelling and oedema in the right hemisphere. Follow-up imaging showed diffuse atrophy and gliosis throughout the right hemisphere. The cause of the seizure syndrome  was confirmed as Angelman syndrome. He has residual dense left hemiparesis, in addition to the phenotypic features of Angelman syndrome. Conclusions: These cases illustrate the need for prompt treatment of status epilepticus to avoid cerebral ischaemic-metabolic injury, a rare but devastating complication, and not previously reported to occur in this manner.  More specific risk factors for this type of injury are unknown and warrant further study. The reason for the apparent predilection for the right hemisphere is unclear.  Funding: N/A