Indian Journal of Critical Care Case Report

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VOLUME 3 , ISSUE 6 ( November-December, 2024 ) > List of Articles

Clinicopathological Correlation

An Unusual Cause of Seizures Leading to Sudden Death: Clinicopathological Correlation

Soham Sen, Santosh Singh, Arijit Sen, Kshitij Srivastava, Barun K Chakrabarty

Keywords : Acute heart failure, Bleeding, Cardiac arrest, Cardiac seizures, Case report, Chronic thromboembolism, Coagulopathy, Pulmonary embolism, Streptokinase, Thrombolysis

Citation Information : Sen S, Singh S, Sen A, Srivastava K, Chakrabarty BK. An Unusual Cause of Seizures Leading to Sudden Death: Clinicopathological Correlation. 2024; 3 (6):147-153.

DOI: 10.5005/jp-journals-11006-0143

License: CC BY-NC 4.0

Published Online: 19-10-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Abstract

Introduction: Sudden cardiac arrest is an emergency that claims millions of lives annually. The causes can be extremely varied. A thorough history, clinical examination, including effective bedside investigations like point-of-care ultrasound (POCUS), two-dimensional (2D) echo, and urgent neuroimaging, if indicated, are indispensable in diagnosis. Brief case summary: In this report, we describe the case of a 40-year-old male who presented with complaints of sudden loss of consciousness, followed by recurrent seizures. He was found to be in cardiac arrest and was successfully revived by cardiopulmonary resuscitation (CPR). Bedside evaluation using POCUS suggested right ventricular dysfunction and deep vein thrombosis (DVT) of the left popliteal vein. Clinical suspicion of pulmonary thromboembolism (PTE) was confirmed on computed tomography (CT) pulmonary angiography. The presence of stroke or cerebral venous thrombosis was ruled out. He was diagnosed with and managed for PTE that caused right heart failure and cardiac arrest. A pathological autopsy was conducted, which confirmed the presence of PTE and demonstrated evidence of acute as well as chronic thromboembolism in multiple arteries and veins. Occult malignancy was ruled out. The etiology of chronic thrombotic conditions remained elusive. Discussion: Seizures as the presenting feature of PTE have been infrequently reported. The proposed mechanism involves sudden cerebral hypoperfusion due to cardiac failure. The presence of multiple arterial and venous thromboembolisms points toward a systemic prothrombotic state. During the discussion, several potential causes were explored, including coronavirus disease (COVID), vaccination status, alcohol intake, chronic liver disease, and drug abuse, each supported by relevant findings from the case.


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