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Case report: Recurrent postictal pulmonary edema
Abstract:
A 32-year-old man with a long history of grand mal seizures but otherwise good health had recurrent episodes of postictal pulmonary edema when he failed to take anticonvulsant medication regularly. This case illustrates most of the features observed in other reported cases of postictal pulmonary edema. Symptoms include dyspnea and cough with production of various quantities of mucoid fluid that may be copious and frankly hemorrhagic. Blood pressure is normal, and temperature may be normal also but is frequently elevated to 100 or 101 F. No cardiac irregularities are heard on auscultation, and the ECG is often normal, but a wide range of abnormalities may be seen. Considerable arterial hypoxemia may occur, and leukocytosis (11,000 to 14,000 cells per cubic millimeter) is common. Rales and rhonchi are audible, and chest films often show bilateral upper and middle lobe infiltrates. The patient is usually clinically improved within 24 hours and the pulmonary edema completely cleared in three to five days.
Insights
Recurrent pulmonary edema after seizures can occur, especially with missed anticonvulsant medication. This condition, postictal pulmonary edema, presents with specific respiratory and clinical signs, resolving within days.
Area of Science:
- Neurology
- Pulmonology
- Critical Care Medicine
Background:
- Epilepsy management often involves regular anticonvulsant medication.
- Seizures can precipitate various acute medical complications.
- Postictal pulmonary edema is a recognized but less common complication.
Observation:
- A case of recurrent postictal pulmonary edema in a patient with grand mal seizures is presented.
- Symptoms included dyspnea, cough with mucoid or hemorrhagic fluid, and hypoxemia.
- Physical examination revealed rales and rhonchi, with chest imaging showing bilateral infiltrates.
Findings:
- Patients often present with normal blood pressure but may have elevated temperature.
- Electrocardiogram (ECG) can be normal or show various abnormalities.
- Leukocytosis and significant arterial hypoxemia are common findings.
Implications:
- This case highlights the importance of medication adherence in epilepsy patients.
- Understanding postictal pulmonary edema aids in timely diagnosis and management.
- Prompt treatment leads to clinical improvement within 24 hours and resolution in 3-5 days.