Unidade de Terapia Intensiva, Hospital Maciel, ASSE - Montevidéu, Uruguai.
Serviço de Neurologia, Hospital de Clínicas Doctor Manuel Quintela - Montevidéu, Uruguai.
Rev Bras Ter Intensiva. 2022 Jan-Mar;34(1):197-201. doi: 10.5935/0103-507X.20220014-pt.
Subarachnoid hemorrhage is a prevalent disease with high morbidity and mortality. Numerous complications contribute to brain injury and defy the clinical practitioner on diagnosis and management. Valproate-associated hyperammonemic encephalopathy is a rare, underdiagnosed, serious and important entity to consider. We present a case of a patient with subarachnoid hemorrhage who received anticonvulsant prophylaxis with valproate and developed neuroworsening associated with high levels of ammoniemia and periodic discharge electroencephalographic patterns without other identifiable causes. Discontinuing valproic acid treatment and normalization of ammoniemia resulted in improvement in clinical and electroencephalographic neurological status.
蛛网膜下腔出血是一种发病率和死亡率都很高的常见疾病。许多并发症导致脑损伤，给临床医生的诊断和治疗带来挑战。丙戊酸相关性高氨血症性脑病是一种罕见、诊断不足、严重且重要的需要考虑的疾病。我们报告了一例蛛网膜下腔出血患者，该患者接受丙戊酸钠预防抗癫痫治疗，随后出现神经恶化，伴有高氨血症和周期性放电脑电图模式，无其他可识别的原因。停用丙戊酸治疗和氨血症正常化导致临床和脑电图神经状态改善。
