Abstracts

Rationale: Status epilepticus (SE) have heterogeneous etiopathologies. The nature and location of lesions diagnosed pre-mortem may not always correlate with those observed at autopsy. We evaluated the neuropathological features associated with fatal SE with an emphasis on anatomy and etiology, and attempted to correlate it with the clinical observations. Methods: One hundred (n=100; M:F=64:36) autopsied cases of status epilepticus were studied retrospectively with emphasis on clinicopathological characteristics/correlation. Results: Majority of the patients (65%) presented for the first time as “de novo” cases of SE. Patients with prior history of epilepsy (35%), had stopped treatment in 71.4% of cases, resulting in SE. Majority of patients with SE had generalized convulsive SE (75%). The mean GCS score at admission was 4.4. The median delay in initiating treatment was 23.5 hours (mean: 29.5 ±32.8 hours). Symptomatic etiology was observed in two thirds, neuroinfection (n=34) and stroke (n=16) being common. Frontal lobe was most commonly involved (38.6%), in localized and multilobar pathology. Dual pathology was observed in 7 patients. A good clinicopathological correlation was possible in 58%. The discordance was observed in 42 patients due to low index of suspicion for additional insults, incorrect neuroimaging interpretation and non-availability complete diagnostic evaluation. Conclusions: This is one of the largest series of fatal SE with pathological correlation in the literature. Clinico-pathological discordance was observed in 42% of patients. Neuroinfection and stroke were noted in 2/3rd of patients. Prolonged duration of SE, long delay before initiating treatment, poor GCS score at admission, poor drug compliance and symptomatic etiologies were common in this cohort of fatal SE from a developing country, most of which could be avoidable or preventable.