Which physical findings are characteristic of status epilepticus (SE)?

Updated: Feb 13, 2018
  • Author: Julie L Roth, MD; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Answer

Generalized convulsive status epilepticus often is recognizable to the clinician at the bedside when typical rhythmic tonic-clonic activity is present. Consciousness is impaired. Rarely, status epilepticus may present as a persistent tonic seizure.

A number of features on physical examination may provide information about the underlying cause of SE. Needle track marks might suggest SE secondary to the use of illicit, or street, drugs. Features on neurologic examination can also be helpful.

Papilledema, a sign of increased intracranial pressure, suggests a possible mass lesion or brain infection. Lateralized neurologic features, such as increased tone, asymmetric reflexes, or lateralized features of the movement during SE itself, are suggestive of the seizures beginning in a localized region of the brain, and they may suggest a structural brain abnormality.

Rapid repeated extensor or flexor posturing may be confused with convulsive activity by a casual observer. Repetitive myoclonus in a comatose patient following diffuse hypoxic brain injury may simulate generalized seizures. The physiologic origin of the myoclonic jerks may not be cortical. The myoclonus usually is limited in duration to several hours.

Suspect subtle status epilepticus or transformed status epilepticus in any patient who does not have improving level of consciousness within 20-30 minutes of cessation of generalized seizure activity. The motor expression of the abnormal cortical electrical activity may change so that a flicker of an eyelid or twitch of an extremity is the only sign of the ongoing generalized electrical discharges. Motor activity may be absent even in the presence of ongoing electrical status epilepticus.

Associated injuries that may be present in patients with seizures include tongue lacerations (typically lateral), shoulder dislocations, head trauma, and facial trauma.


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