Besides being a treatment option for narcolepsy, γ-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 γ-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 γ-hydroxybutyrate. Thus, fixed and dilated pupils that are asymmetric seem to be an important side effect of γ-hydroxybutyrate therapy that may mimic cerebral herniation in deeply anesthetized patients.
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1 November 2008
Cases of Note|
November 01 2008
Mimicking of Cerebral Herniation Through γ-Hydroxybutyric Acid Therapy
M. Klein, MD;
M. Klein, 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.
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J. Remi, MD;
J. Remi, 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.
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A. Straube, MD;
A. Straube, 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.
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S. Weckbach, MD;
S. Weckbach, 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.
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T. Pfefferkorn, MD
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.
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Am J Crit Care (2008) 17 (6): 593–596.
Citation
M. Klein, J. Remi, H.W. Pfister, A. Straube, T.A. Rupprecht, S. Weckbach, T. Pfefferkorn; Mimicking of Cerebral Herniation Through γ-Hydroxybutyric Acid Therapy. Am J Crit Care 1 November 2008; 17 (6): 593–596. doi: https://doi.org/10.4037/ajcc2008.17.6.593
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