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7550887 
Journal Article 
OEDEME CEREBRAL AVEC HYPERAMMONIEMIE AU COURS D'UNE INTOXICATION PAR LE VALPROMIDE. REVELATION, CHEZ UN ADULTE, D'UN DEFICIT PARTIEL EN CARBAMYLPHOSPHATE SYNTHETASE DE TYPE I 
Bourrier, P; Varache, N; Alquier, P; Rabier, D; Kamoun, P; Lorre, G; Alhayek, G 
1988 
1 
La Presse Médicale
ISSN: 0755-4982
EISSN: 2213-0276 
17 
39 
2063-2066 
French 
A case of cerebral oedema developed during an apparently common attempted suicide with valpromide is reported. The most conspicuous biochemical abnormality was hyperammonaemia. The oedema proved refractory to the standard medical treatment of intracranial hypertension, and decompressive craniectomy was performed with only minor sequelae. The cerebral oedema with hyperammonaemia syndrome led to the discovery, in this hitherto asymptomatic adult subject, of a 50 per cent deficiency in type I carbamyl phosphate synthetase liver activity. By completing such a deficiency, valproate may produce an extremely serious syndrome resembling the neonatal encephalopathy due to complete enzyme deficiencies in the urea cycle. All valpromide or valproate intoxications probably are cerebral oedemas with hyperammonaemia akin to Reye's syndrome. All accidents of this type occurring during treatment or poisoning with valproate should be investigated for urea cycle enzyme abnormalities. 
carbamate kinase; clorazepate dipotassium; valproic acid; valpromide; ammonia; anticonvulsive agent; carbamoyl phosphate synthase; drug derivative; urea; valproic acid; valpromide; adult; brain edema; case report; craniectomy; drug intoxication; enzyme deficiency; human; hyperammonemia; male; normal value; oral drug administration; priority journal; suicide attempt; urea cycle; article; blood; brain edema; disorders of amino acid and protein metabolism; iatrogenic disease; metabolism; nutritional deficiency; Adult; Amino Acid Metabolism, Inborn Errors; Ammonia; Anticonvulsants; Brain Edema; Carbamoyl-Phosphate Synthase (Ammonia); Case Report; English Abstract; Human; Male; Suicide, Attempted; Urea; Valproic Acid 
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