Hill Katherine A, Peters John J, Schaefer Sara M
Yale School of Medicine, New Haven, CT, USA.
Section of Neurology, Yale School of Medicine, New Haven, CT, USA.
Acute Crit Care. 2023 Nov;38(4):509-512. doi: 10.4266/acc.2021.01452. Epub 2022 Mar 24.
Myoclonic status epilepticus (MSE) is a sign of severe neurologic injury in cardiac arrest patients. To our knowledge, MSE has not been described as a result of prolonged hyperpyrexia. A 56-yearold man with coronavirus disease 2019 presented with acute respiratory distress syndrome, septic/hypovolemic shock, and presumed community-acquired pneumonia. Five days after presentation, he developed a sustained fever of 42.1°C that did not respond to acetaminophen or ice water gastric lavage. After several hours, he was placed on surface cooling. Three hours after fever resolution, new multifocal myoclonus was noted in the patient's arms and trunk. Electroencephalography showed midline spikes consistent with MSE, which resolved with 40 mg/kg of levetiracetam. This case demonstrates that severe hyperthermia can cause cortical injury significant enough to trigger MSE and should be treated emergently using the most aggressive measures available. Providers should have a low threshold for electroencephalography in intubated patients with a recent history of hyperpyrexia.
肌阵挛性癫痫持续状态（MSE）是心脏骤停患者严重神经损伤的一种表现。据我们所知，尚未有因长时间高热导致MSE的相关描述。一名56岁的2019冠状病毒病男性患者出现急性呼吸窘迫综合征、感染性/低血容量性休克及疑似社区获得性肺炎。就诊5天后，他出现持续发热，体温达42.1°C，对乙酰氨基酚或冰水洗胃均无反应。数小时后，对其进行体表降温。体温恢复正常3小时后，发现患者手臂和躯干出现新的多灶性肌阵挛。脑电图显示中线棘波，符合MSE表现，静脉注射40mg/kg左乙拉西坦后症状缓解。该病例表明，严重高热可导致足以引发MSE的皮质损伤，应采用最积极的措施进行紧急治疗。对于近期有高热病史的插管患者，临床医生应降低脑电图检查的阈值。
