Case Report Evolution of Cerebral Atrophy in a Patient with Super Refractory Status Epilepticus Treated with Barbiturate Coma Christopher R. Newey, 1 Pravin George, 2 Premkumar Nattanmai, 1 Christine Ahrens, 3 Stephen Hantus, 2,4 and Aarti Sarwal 5 1 Department of Neurology, University of Missouri, 5 Hospital Drive, CE 540, Columbia, MO 65211, USA 2 Cleveland Clinic, Department of Neurology, Cerebrovascular Center, 9500 Euclid Avenue, Cleveland, OH 44125, USA 3 Cleveland Clinic, Department of Pharmacy, 9500 Euclid Avenue, Cleveland, OH 44125, USA 4 Cleveland Clinic, Department of Neurology, Epilepsy Center, 9500 Euclid Avenue, Cleveland, OH 44125, USA 5 Wake Forest University School of Medicine, Neurology and Critical Care (Anesthesia), Reynolds M, Medical Center Blvd, Winston Salem, NC 27157, USA Correspondence should be addressed to Christopher R. Newey; neweyc@health.missouri.edu Received 30 August 2016; Revised 1 December 2016; Accepted 12 December 2016; Published 15 January 2017 Academic Editor: Samuel T. Gontkovsky Copyright © 2017 Christopher R. Newey et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Status epilepticus is associated with neuronal breakdown. Radiological sequelae of status epilepticus include difusion weighted abnormalities and T2/FLAIR cortical hyperintensities corresponding to the epileptogenic cortex. However, progressive generalized cerebral atrophy from status epilepticus is underrecognized and may be related to neuronal death. We present here a case of difuse cerebral atrophy that developed during the course of super refractory status epilepticus management despite prolonged barbiturate coma. Methods. Case report and review of the literature. Case. A 19-year-old male with a prior history of epilepsy presented with focal clonic seizures. His seizures were refractory to multiple anticonvulsants and eventually required pentobarbital coma for 62 days and midazolam coma for 33 days. Serial brain magnetic resonance imaging (MRI) showed development of cerebral atrophy at 31 days afer admission to our facility and progression of the atrophy at 136 days afer admission. Conclusion. Tis case highlights the development and progression of generalized cerebral atrophy in super refractory status epilepticus. Te cerebral atrophy was noticeable at 31 days afer admission at our facility which emphasizes the urgency of defnitive treatment in patients who present with super refractory status epilepticus. Further research into direct efects of therapeutic coma is warranted. 1. Introduction Status epilepticus is a neurological emergency with signifcant morbidity and mortality [1]. It can be refractory to standard frst- and second-line medications in 23–43% cases [2]. If status epilepticus continues afer the induction of anesthesia, it is termed super refractory status epilepticus [3]. Super refractory status epilepticus itself portends many long-term complications and sequelae now increasingly being recog- nized [3, 4]. Focal cerebral atrophy is a well-known phenomenon afer prolonged seizures or status epilepticus. However, global cerebral atrophy is less characterized. Global cerebral atrophy in refractory status epilepticus may be a result of prolonged critical illness, progression of underlying brain pathology causing seizures independent of the status epilepticus, or direct efect of high doses of antiepileptic agents used to treat the status epilepticus [4, 5]. Elucidation of pathophysiology and triggers might help in emphasizing clinical paradigms of management that lead to better outcomes. We present a case of progressive generalized cerebral atrophy in a patient with super refractory status epilepticus treated with prolonged barbiturate coma. 2. Case Te patient is a 19-year-old male with a past medical history of autism (reads at 3rd/4th grade level), lower extremity Hindawi Publishing Corporation Case Reports in Neurological Medicine Volume 2017, Article ID 9131579, 4 pages http://dx.doi.org/10.1155/2017/9131579