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Woman with seizures

  • Zhen Hu
    Affiliations
    Department of Emergency, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
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  • Wei Wen
    Correspondence
    Corresponding author.
    Affiliations
    Department of Emergency, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
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  • Xutao Wang
    Affiliations
    Department of Emergency, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
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  • Xinchao Zhang
    Affiliations
    Department of Emergency, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, P.R. China
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      A 66-year-old woman with a history of hyperlipidemia presented to the emergency department after a epileptic seizure episode for nearly 1 min. She had a normal temperature, pulse rate was 77 beats/min, blood pressure was 85/40 mm Hg, and pulse oximetry was 92% on room air.She felt chest tightness when exercise for 1 week. Laboratory test was significant for cardiac troponin I level of 0.12 ng/ml, B-type natriuretic peptide lever of 866.96 pg/ml, D-dimer lever of 2520 ng/ml. She had a head computerized tomography of no cerebral hemorrhage or infarction. The emergency physician prescribed sodium valproate to Control the seizures. And the physician performed point-of-care ultrasonography (Fig. 1 and Video 1). Diagnosis was confirmed with computer tomography pulmonary angiography (CTPA, Fig. 2).
      Fig. 1
      Fig. 1Parasternal short axis view of transthoracic echocardiography showing “D”sign:the compressed left ventricle, abnormal septal shape(arrow),and the dilated right ventricle(star).
      Fig. 2:
      Fig. 2CTPA showing filling-defect of bilateral pulmonary artery Trunk (arrow).

      Diagnosis

      Acute Pulmonary embolism. CTPA scan demonstrated Extensive pulmonary embolism in both pulmonary artery trunk. Intravenous Alteplase rt-PA were administered. After 10 days hospitalization, she was discharged from hospital with Rivaroxaban.6 months after discharge date, the follow-up CT scan showed no pulmonary embolism (Fig. 3).
      Fig. 3
      Fig. 3Follow-up CTPA showing no filling-defect of bilateral pulmonary artery Trunk.
      It is rare that seizure is the first clinical manifestation of acute pulmonary embolism [
      • Zuin M.
      • Rigatelli G.
      • Zuliani G.
      • et al.
      Seizures as the first clinical manifestation of acute pulmonary embolism: an underestimate issue in neurocritical care.
      ,
      • WANG Jian-wen
      • XU Ming-wei
      • LUO Ben-yan
      Pulmonary embolism presenting as recurrent transient loss of consciousness: syncope and seizure.
      ]. point-of-care ultrasonography is a useful tool for physicians to diagnose rapidly whether acute Pulmonary embolism exists or not [
      • Squizzato A.
      • Galli L.
      • Gerdes V.E.
      Point-of-care ultrasound in the diagnosis of pulmonary embolism.
      ], especially for unstable patients.

      Funding

      This work was supported by Peking Union Medical Foundation–Ruiyi Emergency Medical Research Fund (R2018028).

      Declaration of Competing Interest

      All authors declare no conflict of interest.

      Appendix. Supplementary materials

      References

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        • Rigatelli G.
        • Zuliani G.
        • et al.
        Seizures as the first clinical manifestation of acute pulmonary embolism: an underestimate issue in neurocritical care.
        Neurol Sci. 2020; 41: 1427-1436
        • WANG Jian-wen
        • XU Ming-wei
        • LUO Ben-yan
        Pulmonary embolism presenting as recurrent transient loss of consciousness: syncope and seizure.
        Chin Med J. 2013; 126: 193-194
        • Squizzato A.
        • Galli L.
        • Gerdes V.E.
        Point-of-care ultrasound in the diagnosis of pulmonary embolism.
        Crit Ultrasound J. 2015; 7: 7-10