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Year : 2015  |  Volume : 9  |  Issue : 3  |  Page : 105-108

Cortical laminar necrosis due to refractory status epilepticus in a kidney transplant patient with cryptococcal meningitis

1 Institute of Renal Sciences, Global Hospital, Mumbai, India
2 Department of Neurology, Global Hospital, Mumbai, India
3 Department of Radiology, Global Hospital, Mumbai, India

Correspondence Address:
Zaheer Virani
Institute of Renal Sciences, Global Hospital, Mumbai
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Source of Support: None, Conflict of Interest: None

DOI: 10.1016/j.ijt.2015.10.010

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A 56-year-old diabetic male underwent kidney transplant in 2010. He was brought to the hospital with complaints of vomiting and altered sensorium of 10 days duration. Lumbar puncture revealed cryptococcal meningitis. He was promptly initiated on liposomal amphotericin B and flucytosine. Immunosuppressive agents tacrolimus and mycophenolate mofetil were discontinued. There was an initial improvement in his sensorium but a few days later, he developed super-refractory status epilepticus. Despite early and aggressive management of seizures with multiple anti-epileptic drugs including intravenous anesthesia with thiopentone, his seizures persisted. This unfortunately led to cortical laminar necrosis, a condition in which there is severe brain injury. This condition is commonly a consequence of hypoxic ischemic encephalopathy, hypoglycaemic encephalopathy, status epilepticus, or ischemic stroke, and most patients either progress to brain death or remain in a persistent vegetative state.

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