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American Journal of Critical Care. 2008;17: 593-596
Copyright © 2008 by the American Association of Critical-Care Nurses.
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Cases of Note features peer-reviewed case reports and case series that document clinically relevant findings from critical and high acuity care environments. Cases that illuminate a clinical diagnosis or a management issue in the treatment of critically and acutely ill patients and include discussion of the patient’s experience with the illness or intervention are encouraged. Proposals for future Cases of Note articles may be e-mailed to ajcc{at}aacn.org.

Mimicking of Cerebral Herniation Through {gamma}-Hydroxybutyric Acid Therapy

By M. Klein, MD, J. Remi, MD, H.W. Pfister, MD, A. Straube, MD, T.A. Rupprecht, MD, S. Weckbach, MD and T. Pfefferkorn, MD. M. Klein, J. Remi and T. A. Rupprecht are residents, H. W. Pfister and A. Straube are professors, and T. Pfefferkorn is a fellow in the Department of Neurology, Klinikum Großhadern, Ludwig-Maximilian University, Munich, Germany. S. Weckbach is a resident in the Department of Radiology, Klinikum Großhadern, Ludwig-Maximilian University.

Corresponding author: Matthias Klein, MD, Department of Neurology, Neurologic Intensive Care Unit, Ludwig-Maximilian University, Marchioninistr. 15, 81377 Munich, Germany (e-mail: matthias.klein{at}med.uni-muenchen.de)

Besides being a treatment option for narcolepsy, {gamma}-hydroxybutyrate is used as an adjuvant during anesthesia in Europe. In addition, it is illegally used as a recreational drug. Fixed and dilated, asymmetric pupils developed in 2 patients during continuous therapy with intravenous {gamma}-hydroxybutyrate, which was added to the long-term anesthetics fentanyl and midazolam. Cerebral herniation as an alternative cause for the pupillary changes was ruled out by using continuous intracranial pressure monitoring and computed tomography. In both patients, the pupillary abnormalities resolved after discontinuation of {gamma}-hydroxybutyrate. Thus, fixed and dilated pupils that are asymmetric seem to be an important side effect of {gamma}-hydroxybutyrate therapy that may mimic cerebral herniation in deeply anesthetized patients.






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Copyright © 2008 by the American Association of Critical-Care Nurses.