Approach to convulsive status epilepticus Quiz: Ace Your Exams
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A 19-year-old man is brought by ambulance to the emergency department for altered mental status and seizure activity. He had been drinking alcohol with his friends for the past several hours when they realized he was absent from the house. He was found prone in the backyard, surrounded by emesis, and unresponsive to voice and tactile stimulation. He developed diffuse tonic extension of the limbs and rhythmic jerking that has persisted upon arrival despite administration of two doses of intravenous lorazepam. A finger-stick glucose is normal. Temperature is 37.2°C (99°F), pulse is 80/min, respirations are 12/min, blood pressure is 120/80, and oxygen saturation is 85% on room air. On exam, bilateral eyes are open and deviated upwards. He does not respond to verbal commands nor painful stimuli. Pulmonary exam reveals decreased breath sounds and crackles throughout. Bilateral upper extremities are flexed, and his bilateral lower extremities are extended with rhythmic jerking in both the upper and lower extremities. A bolus of levetiracetam is infused. Which of the following is most likely to confirm the direct cause of this patient’s seizure activity?
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