Non-Hyperammonemic valproate encephalopathy (original) (raw)

2014, Annals of Neurosciences

Patient reported to neurology outpatient with history of altered sensorium and gait umsteadiness for 1 Week with history of increase in valproate dose to 400 mg BD 2 weeks back by some personal physician. There was no history of yellowish discoloration of urine or eyes. He did not complain of fever, headache, vomiting, and stiffness in the neck or any exacerbation of seizure. On examination he was drowsy, disoriented providing inappropriate answers to questions. His pulse 86 beats per minute regular. BP was 100/70 mmHg. The respiratory rate was found to be 16 breaths per minute Plantars were bilaterally downwards with no focal neurological deficit. He was drowsy and over next 2 days he remained stuporous. The meningeal signs were absent. Examination of cranial nerves and motor system was normal. Deep tendon jerks were elicited in all 4 limbs. Plantar reflex was bilaterally flexor. Abdominal reflexes were present in all quadrants. Examination of sensory system was normal. Other systemic examination was unremarkable. Patient was admitted and evaluated in ward for acute worsening. Following biochemical parameters were analysed and found to Complete blood count, Liver function tests, kidney function tests, blood sugar, Routine urine examination was normal, Arterial blood gas analysis, Blood and urine culture tests were normal. ECG and chest X-ray were normal. CSF analysis was also normal.

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