Case history

A 75-year-old woman, who was recovering from a recent episode of urosepsis, presented with 3 days of recurrent focal motor seizures affecting the right arm. She was aware and orientated throughout each episode but experienced confusion and weakness afterwards. On examination, she had mild pyramidal weakness of the right arm. CT scan of head showed no acute abnormality. She was started on levetiracetam. Her history included type 2 diabetes mellitus, posterior circulation stroke, and known asymptomatic meningiomas at the left frontal lobe and left parietal lobe. She had no personal or family history of seizures.

Her seizures became more frequent despite rapid titration of levetiracetam, with later addition of sodium valproate and phenytoin. Five days later, her condition rapidly decompensated and progressed into generalised convulsive status epilepticus, refractory to lorazepam, phenytoin, sodium valproate, levetiracetam and midazolam. She was transferred to the …