Darnell J C, Jay S J
Epilepsia. 1982 Feb;23(1):71-83. doi: 10.1111/j.1528-1157.1982.tb05054.x.
A 37-year-old woman with a post-traumatic seizure disorder had four well-documented episodes of postictal acute pulmonary edema and respiratory failure. Subtherapeutic blood concentrations of phenytoin were documented on each admission. Each episode followed one or more grand mal seizures and was characterized by the development of diffuse nodular-appearing alveolar infiltrates, tachypnea, and severe hypoxemia that rapidly resolved with supportive therapy. There was no evidence of gastric acid aspiration, acute lung infection, or underlying heart or lung disease. To determine the frequency of postictal pulmonary edema in our institution, we reviewed the clinical records and chest roentgenograms of 45 consecutive patients who were admitted to our emergency room following a well-documented grand mal seizure. Only one patient (described in this report) had chest roentgenographic evidence of pulmonary edema. A review of the English literature revealed only 11 reported cases of postictal pulmonary edema since 1965 and a total of 42 episodes in 27 patients since 1908. There were no clearly documented cases of postical pulmonary edema following electroconvulsive therapy in 18 published reports totaling more than 38,000 subjects. Our findings suggest that while postictal pulmonary edema may occur repeatedly in the same patient, the overall frequency of this complication is low.
一名患有创伤后癫痫障碍的37岁女性出现了4次有充分记录的发作后急性肺水肿和呼吸衰竭。每次入院时均记录到苯妥英钠血药浓度低于治疗水平。每次发作均继发于一次或多次癫痫大发作，其特征为出现弥漫性结节状肺泡浸润、呼吸急促和严重低氧血症，经支持治疗后迅速缓解。没有证据表明存在胃酸误吸、急性肺部感染或潜在的心肺疾病。为了确定我院发作后肺水肿的发生率，我们回顾了45例因有充分记录的癫痫大发作后入住我院急诊室的连续患者的临床记录和胸部X线片。只有1例患者（即本报告中描述的患者）有肺水肿的胸部X线证据。对英文文献的回顾显示，自1965年以来仅报告了11例发作后肺水肿病例，自1908年以来27例患者共发生42次发作。在18篇发表的报告中，涉及超过38000名受试者，没有关于电休克治疗后发作后肺水肿的明确记录病例。我们的研究结果表明，虽然发作后肺水肿可能在同一患者中反复发生，但这种并发症的总体发生率较低。
