The daily educational pearl – altered mental state after a witnessed seizure

Your next patient was witnessed to have a tonico-clonic seizure 30 min ago. He remains GCS 6. Why might that be?

Causes of persisting altered mental state following a seizure

– status epilepticus

– iatrogenic (i.e. given benzodiazepines prehospital or in ED)

– normal postictal state

– persisting cause (of seizure + AMS): hypoNa / hypoglycaemia / toxins / SAH / intracerebral haemorrhage / meningitis / encephalitis

– complications of the ictal state – hypoxic brain injury / severe metabolic acidosis