학술논문
Focal-onset seizure due to left internal carotid artery dissection in the context of confounding hyperglycaemia
Document Type
Academic Journal
Author
Source
Oxford Medical Case Reports. March 2022, Vol. 2022 Issue 3, p123, 5 p.
Subject
Language
English
ISSN
2053-8855
Abstract
INTRODUCTION The annual incidence of carotid artery dissection is approximately 2.5-3 per 100 000 patients [1]. Causes are either traumatic or atraumatic. Presentation can include seizures, headaches or even focal [...]
A 36-year-old diabetic woman presented to hospital with a seizure that started with shaking of the right hand which sequentially progressed to the entire right side of the body with associated loss of consciousness. Capillary Blood Glucose was 29 mmol/L. HbA1c was 133 mmol/L. Non-contrast computerised tomography (CT) scan of the brain was normal suggesting that the cause of her seizure was hyperglycaemia. However, Magnetic Resonance Imaging (MRI) of the brain showed infarcts in the left paracentral lobule and caudate nucleus. It also identified loss of signal flow void in the intracranial segment of the left internal carotid artery (ICA) raising the suspicion for thrombosis secondary to dissection. This was later confirmed on CT angiogram. This case demonstrates how the initial CT Head was non-diagnostic. We stress the importance of taking a careful seizure history and subsequently obtaining an MRI scan to fully exclude structural pathology.
A 36-year-old diabetic woman presented to hospital with a seizure that started with shaking of the right hand which sequentially progressed to the entire right side of the body with associated loss of consciousness. Capillary Blood Glucose was 29 mmol/L. HbA1c was 133 mmol/L. Non-contrast computerised tomography (CT) scan of the brain was normal suggesting that the cause of her seizure was hyperglycaemia. However, Magnetic Resonance Imaging (MRI) of the brain showed infarcts in the left paracentral lobule and caudate nucleus. It also identified loss of signal flow void in the intracranial segment of the left internal carotid artery (ICA) raising the suspicion for thrombosis secondary to dissection. This was later confirmed on CT angiogram. This case demonstrates how the initial CT Head was non-diagnostic. We stress the importance of taking a careful seizure history and subsequently obtaining an MRI scan to fully exclude structural pathology.