There were some overlapping clinical signs and symptoms that made the diagnosis difficult such as: 1) generalized myoclonic-like movement 2) tongue biting 3) repeated syncopal episodes in a short period. Patient experienced transient LOC during this period, but he eventually stabilized. Subsequent AICD interrogation revealed several corresponding episodes of ventricular-tachycardia and fibrillation (V-tack/fib). The patient was then admitted to coronary care unit (CCU), treated with amiodarone and electrolyte correction. The cardiologist who had been working with this patient was called and the generalized seizure-like activities were then attributed to transient cerebral hypoperfusion secondary to cardiac arrhythmia. The differential diagnosis raised was epileptic seizures versus generalized convulsion secondary to cardiogenic syncope. Patient subsequently stabilized with appropriate medical treatment. The heart function continued to worsen during this period as shown by the hypotensive episodes. The laboratory tests at admission are shown in Table 1 and further diagnostic tests are presented in Figures 1 and and2 2.īlood pressure changes after admission. There was tongue biting, without any eye rolling movement, urinary or bowel incontinence. Patient underwent resuscitation by EMS at home and was then sent to the emergency department. The episodes each lasted about 10 - 20 s, and the patient regained responsiveness in between, feeling short of breath, but without any pain. At least two similar episodes occurred before the wife called emergency medical services (EMS). Shortly after, tonic muscle activity with head and arm extension occurred and then myoclonic jerks of arms and legs started. He then felt nauseous and lightheaded, fell into a chair, and subsequently passed out. The patient admitted experiencing a feeling of heat first, which drove him to the refrigerator for a cold drink. The patient’s wife witnessed the generalized physical shaking. A 57-year-old man with previous medical history of hypertension, ventricular tachycardia storms, cardiac arrest, chronic systolic congestive heart failure (CHF) with ejection fraction (EF) of 10%, for which he had an AICD placed, chronic kidney disease, and anemia was brought to the emergency department after episodes of seizure-like activities at home.
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