Abstracts

RATIONALE: METHODS: Case Report. RESULTS: A 79 year-old woman with hypertension, hyperthyroidism, and remote thoracic Pott's disease presented with several years of paroxysmal episodes of chest pain. These lasted 1-3 minutes, and were sometimes relieved by nitroglycerine. One episode of chest pain, treated with two sublingual nitroglycerin tablets, was followed by transient lethargy and confusion. Symptoms persisted despite anti-anginal medications, including calcium channel blockers. Cardiac evaluation, including coronary angiography, was normal. An EEG showed frequent epileptiform discharges in the right anterior temporal lobe. A three-day ambulatory EEG was obtained. Occasional right temporal sharp waves were again noted. One typical episode of chest pain was recorded; the EEG demonstrated a right temporal seizure lasting approximately one minute. She was placed on Dilantin and has been free of chest pain for five months. CONCLUSIONS: Although quite unusual, atypical chest pain can be the sole manifestation of epilepsy, and should be considered in the differential diagnosis of refractory chest pain with a negative cardiac evaluation.