Abstract:

Objective To explore the clinical characteristics and diagnosis and treatment of acute pulmonary embolism (APE) with epilepsy attack as the first clinical manifestation. Methods The diagnosis and treatment of a case of APE with epilepsy attack as the first clinical manifestation were retrospectively analyzed, and the related literatures were reviewed. Results A 59-year-old female patient exhibited non-night epilepsy attack, manifesting as loss of consciousness, falling to the ground, hanging eyes, tight teeth, tongue biting, and incontinence, without limb twitching. She returned to clear consciousness after 10 minutes. After waking up, she felt dizzy, weak in both lower limbs, and unable to recall. Laboratory testing suggested elevated D-dimer, and blood gas analysis showed hypoxemia and respiratory alkalosis. Electrocardiogram showed sinus rhythm, SIQ_ⅢT_Ⅲ, and extensive low, flat, and inverted T waves. Cardiac color Doppler showed moderate pulmonary hypertension, reduced left ventricular diastolic function, and normal contraction function. Color Doppler of lower limbs showed right intermuscular venous thrombosis, and widened left intermuscular veins. The computed tomography pulmonary angiogram (CTPA) showed multiple pulmonary embolisms on both sides, and a mild widening of the main trunk of pulmonary artery. Conclusion The symptoms of APE are diverse and occult. An alert of APE is made in case of a history of epilepsy attack without brain injuries, elevated D-dimer, and sinus rhythm SIQ_ⅢT_Ⅲ, and extensive low, flat, and inverted T waves on electrocardiogram. Cautions should be made to prevent misdiagnoses. A timely treatment favors the prognosis.

Key words: epilepsy, pulmonary embolism, electrocardiography, lung CTA