Severe pulmonary congestion in a near miss at the first seizure: Further evidence for respiratory dysfunction in sudden unexpected death in epilepsy

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Pezzella M, Striano P, Ciampa C, Errichiello L, Penza P, and Striano S (2009) Severe pulmonary congestion in a near miss at the first seizure: Further evidence for respiratory dysfunction in sudden unexpected death in epilepsy. Epilepsy 2885 Behav 14:4 701–2.

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Abstract: Sudden unexpected death in epilepsy (SUDEP) is the most important direct seizure-related cause of death, and most cases usually occur in patients with intractable, longstanding epilepsy. Suspected mechanisms for SUDEP include central and obstructive apnea, cardiac arrhythmia, postictal respiratory arrest, and primary cessation of brain activity. We report a patient who experienced a near SUDEP following his first prolonged tonic-clonic seizure requiring intubation. Chest X-ray examination showed severe bilateral congestion of the middle and superior pulmonary fields and an enlarged heart. Observations of pulmonary compromise in near-miss patients are extremely rare. Our patient showed marked cyanosis and respiratory distress after the index seizure, in agreement with the view that respiratory distress was the primary etiology in this case. Moreover, this observation confirms that SUDEP is not exclusively an issue for patients with chronic, uncontrolled epilepsy.

Keywords: Sudden unexpected death in epilepsy, Pulmonary congestion, Near miss, First seizure

Context

  • Single-case report of 14 year old male with no seizure history who suffered GTCS then became cyanotic. After intubation chest x-ray showed severe bilateral pulmonary edema and an enlarged heart, though the patient was markedly obese. After 24 hours pulmonary congestion had largely resolved and pulmonary artery pressure was normal. The discussion offers a helpful synposis of other reports of seizure-related pulmonary edema.

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