Seizure : the journal of the British Epilepsy Association
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Review Case Reports
Seizure as the presenting sign for massive pulmonary embolism: case report and review of the literature.
A 50-year-old male with sudden syncope and witnessed seizure activity was discovered to have pulmonary emboli. Although he denied shortness of breath, d-dimer testing was positive and a ventilation-perfusion scan was positive for bilateral pulmonary emboli; cardiac ECHO also confirmed elevated right ventricular pressures. The literature on this unusual presentation for seizures as the initial manifestation of pulmonary embolism is reviewed. Clinicians need to be more aware that pulmonary embolism is important to consider within the differential diagnosis for unexplained new onset of seizure activity.
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Anterior thalamus (AN) has been shown to mediate seizures in both focal and generalized models. Specific regional increase in AN serotonergic activity was observed following AN-DBS in our pentylenetetrazol (PTZ) rodent model of acute seizures, and this increase may inhibit seizures and contribute to the mechanism of anticonvulsant DBS. ⋯ Increased serotonergic activity in AN raised PTZ seizure threshold, similar to DBS, but without preventing cortical bursting. 5-Carboxamidotryptamine, a 5-HT(7) agonist, demonstrated dose-dependent seizure inhibition. Methysergide proved to have an inverse, dose-dependent agonist property, antagonizing the action of AN-DBS at the highest dose. Anticonvulsant AN-DBS may in part act to selectively alter serotonin neurotransmission to raise seizure threshold.