A 45-year-old man with no significant past medical history is admitted to the neurocritical care unit for convulsive status epilepticus. He has been seizing continuously for 30 minutes before emergency medical services (EMS) arrival, at which time he received intravenous lorazepam 4 mg. On arrival (10 minutes later), he remains in active convulsions and is intubated for airway protection, placed on SIMV ventilation, and started on a propofol infusion at 35 mcg/kg/min for sedation. His weight is 70 kg. Vital signs are blood pressure 150/90 mm Hg, heart rate 110 bpm, temperature 38.2 °C. Laboratory values show sodium 138 mEq/L, potassium 4.1 mEq/L, glucose 110 mg/dL, arterial pH 7.27, lactate 5 mmol/L. He then receives a loading dose of fosphenytoin 20 mg PE/kg. Continuous EEG monitoring continues to show generalized spike-and-wave discharges despite these interventions. Therapy is now being escalated to a continuous infusion antiepileptic agent. Given this clinical scenario, which of the following pathophysiological changes is MOST likely responsible for the observed pharmacoresistance to initial benzodiazepine therapy?

A 58-year-old man is in the ICU after severe traumatic brain injury. He is sedated, intubated, and mechanically ventilated. Over the past several hours, nursing staff have observed intermittent eyelid fluttering and nystagmus, with fluctuating levels of consciousness despite stable sedation. Continuous EEG monitoring is in place. Which of the following findings would MOST strongly suggest nonconvulsive status epilepticus (NCSE)?

A 45-year-old man in the intensive care unit on mechanical ventilation following a motor vehicle accident develops continuous, generalized tonic-clonic movements of all four extremities that have persisted for 7 minutes, accompanied by profound unresponsiveness. Prior to this event, he was lethargic but arousable. Based on these findings, which of the following is the most appropriate classification for this neurological event?

A 45-year-old man continues to have generalized tonic-clonic seizure activity for 3 hours despite receiving lorazepam 4 mg IV and phenytoin 15 mg/kg IV. According to current classification, which of the following BEST describes his condition?

A 45-year-old female is admitted to the neurocritical care unit with unexplained altered mental status. She is intubated, on synchronized intermittent mandatory ventilation (SIMV), and receiving a low-dose propofol infusion (20 mcg/kg/min) for sedation. Continuous video-EEG monitoring has been in place since admission. During evening rounds, the nurse reports intermittent, asynchronous bilateral limb jerking movements that began about 10 minutes ago, accompanied by eye fluttering and a fluctuating level of responsiveness. Vital signs are stable, pupils are equal and reactive, and prior labs (electrolytes, glucose, toxicology) are unremarkable. Continuous video-EEG shows diffuse slowing without epileptiform discharges during the reported movements. Given this presentation and EEG findings, what is the most appropriate initial management step?

A 68-year-old man is admitted to the ICU with hypotension (BP 85/50 mm Hg), tachycardia (HR 120 bpm), fever (39.2 °C), and altered mental status. Sepsis is suspected. According to current sepsis guidelines, which emergent laboratory test result will most directly guide initial resuscitation and risk stratification?

A 45-year-old, 70-kg man is admitted to the intensive care unit, currently intubated and on mechanical ventilation for refractory status epilepticus. He has been seizing continuously for approximately 90 minutes before arrival. In the emergency department, he received IV lorazepam 4 mg twice and IV fosphenytoin 20 mg PE/kg (total 1400 mg PE). Despite these interventions, he continues to exhibit intermittent tonic–clonic movements, and continuous EEG monitoring shows ongoing electrographic seizure activity. He is hemodynamically stable on low-dose norepinephrine via a central line. Given this clinical scenario, which of the following statements regarding the role and timing of neuroimaging (CT/MRI) in his management is most appropriate?

A 65-year-old man is in the intensive care unit on synchronized intermittent mandatory ventilation and a propofol infusion for sedation. A triple-lumen central venous catheter is in place for medication administration. He was admitted after a generalized tonic-clonic seizure, which was treated with intravenous lorazepam and a phenytoin load. Twenty-four hours later, he remains unresponsive, and nursing staff report intermittent rhythmic twitching of his left eyelid. Vital signs are stable. Which of the following diagnostic evaluations is most critical for classifying the patient’s condition and guiding further treatment?

A 45-year-old man in the intensive care unit with septic shock on mechanical ventilation develops continuous generalized tonic–clonic seizures for 7 minutes. He is unresponsive with dilated, nonreactive pupils. Which of the following is the most appropriate initial pharmacologic intervention?

A 65-year-old, 70 kg man with chronic kidney disease (baseline creatinine 2.0 mg/dL; estimated GFR 35 mL/min/1.73 m2) and mild hepatic steatosis is intubated and mechanically ventilated in the ICU for continuous generalized tonic–clonic seizures lasting 15 minutes despite two doses of IV lorazepam (total 0.1 mg/kg). Vital signs: BP 110/70 mmHg, HR 62 bpm, Temp 37.2 °C. Labs: AST 45 U/L, ALT 50 U/L, albumin 3.5 g/dL. Which of the following second-line antiseizure medications is the most appropriate next step?