Abstracts

Rationale: Severe pulmonary embolism (PE) can lead to seizures, and the pathophysiology is considered to be transient global cerebral hypo-perfusion. There are only a few reports about seizures caused by PE, and its characteristics remain unclear. PE is a potentially fatal condition, especially when a seizure is present, making early diagnosis significant. With a seizure, clinical evaluation may be compromised by the postictal confusional state. Oxygen desaturation, tachypnea and tachycardia, which are important signs of PE, may be attributed to the seizure. Misdiagnosis may occur unless PE is taken into account. This report aims to assist neurologists recognize the clues regarding the accurate diagnosis of seizures caused by PE.Methods: The consecutive clinical records of PE, treated in our hospital from April 2006 to March 2011, were retrospectively reviewed. These records were analyzed, resulting in the clarification of characteristics of seizures caused by PE. Results: 325 consecutive cases of PE were identified, and the details were available in 291 cases including 44 cases diagnosed incidentally. There were three cases (1.0%) in which the early symptoms included seizures. The three patients had no history of seizures or cardiopulmonary diseases. The 1st patient, a 78-year-old male, suddenly raised his hands over his head and stared at a fixed point for a substantial period of time. On the next evening he complained of dyspnea and was taken to our hospital. He was in cardiopulmonary arrest on arrival, and PE was diagnosed soon thereafter. Despite all the effort, he died on the next day. The 2nd patient, an 87-year-old female, complained of discomfort prior to arrival. The next morning, generalized tonic seizures with conjugated deviation occurred intermittently for approximately 4 hours, with the patient being taken to our hospital. After the seizures, oxygen pressure of arterial blood was 87.2 mmHg on FiO₂ (fraction of inspired oxygen) of 0.5 and the D-dimer value was more than 10 g/ml (normal range: <1.0 g/ml). Mild right ventricular overload and PE were detected. In this case, she was treated successfully with anticoagulation therapy. The 3rd patient, a 78-year-old female, was taken to our hospital because of slight drowsiness, and a generalized tonic-clonic seizure occurred for approximately 5 minutes. After the seizures, oxygen pressure of arterial blood was 244.6 mmHg on FiO