Valproic Acid-Induced Hyperammonemic Encephalopathy as a Cause of Neurologic Deterioration after Unruptured Aneurysm Surgery.
10.3340/jkns.2015.58.2.159
- Author:
Sangkook LEE
1
;
Jinhwan CHEONG
;
Choonghyun KIM
;
Jae Min KIM
Author Information
1. Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea. kjm2323@hanyang.ac.kr
- Publication Type:Case Report
- Keywords:
Hyperammonemia;
Valproic acid;
Encephalopathy
- MeSH:
Ammonia;
Aneurysm*;
Brain;
Diagnosis, Differential;
Diet;
Early Diagnosis;
Female;
Humans;
Hyperammonemia;
Intracranial Aneurysm;
Middle Aged;
Neck;
Reference Values;
Unconsciousness;
Valproic Acid
- From:Journal of Korean Neurosurgical Society
2015;58(2):159-162
- CountryRepublic of Korea
- Language:English
-
Abstract:
Neurological deficits after brain surgery are not uncommon, and correct and prompt differential diagnosis is essential to initiate appropriate treatment. We describe a patient suffering from loss of consciousness due to hyperammonemia, following valproic acid treatment after surgery for an unruptured cerebral aneurysm. A 57-year-old female patient underwent successful aneurysmal neck clipping to correct an unruptured aneurysm. Her postoperative course was good, and she received anti-epileptic therapy (valproic acid) and a soft diet. Within a few days the patient experienced mental deterioration. Her serum valproic acid reached toxic levels (149.40 mg/L), and serum ammonia was fifteen times the upper normal limit (553 mmol/L; normal range, 9-33 mmol/L). After discontinuation of valproic acid and with conservative treatment, the patient recovered without any complications. Valproate-induced hyperammonemic encephalopathy is an unusual but serious neurosurgical complication, and should not be disregarded as a possible cause of neurological deficits after neurovascular surgery. Early diagnosis is crucial, as discontinuation of valproic acid therapy can prevent serious complications, including death.
