Abstract
Introduction
Super-refractory status epilepticus (SRSE) is a critical condition that poses a serious threat to a patient’s neurological outcome, with a high mortality rate, and is defined as a status epilepticus that persists despite 24 hours of treatment with an IV anesthetic, with the possibility of recurrence once the patient is weaned off the anesthetic medication. In Cambodia, there are no documented case reports of SRSE, nor are there established protocols to guide physicians, particularly emergency doctors and intensivists, in managing this condition. This case report aims to raise awareness, highlights diagnostic challenges, and discusses appropriate management strategies in resource-limited settings.
Case Presentation
A 21-year-old Cambodian male patient was admitted to the Medical Intensive Care Unit (ICU-Med) at Khmer-Soviet Hospital because of prolonged unmanageable seizures for four days following fever and extreme headache, with a visual analog score (VAS) of 9/10. The patient had been known to have had epilepsy since his first year of life. Owing to persistent seizures and unresponsiveness to the treatment, the patient was then transferred to the ICU-Med for the management of refractory status epilepticus.
Conclusion
SRSE is extremely rare, and its diagnosis and management are challenging. This case report provides the first evidence to spread the message, findings, management approach, and patient outcomes. The message is that even in a resource-limited situation, we are still able to manage the condition effectively.