A rare presentation of pulmonary thromboembolism as seizure

Toktam Alirezaei, SeyedehFatemeh Mousavi, Hamed Hesami


Acute pulmonary thromboembolism is a critical and sometimes fatal event that is difficult for clinicians to diagnose because of its various initial manifestations. Here, we report a previously healthy 50-year-old man without any history of seizures who presented to the emergency ward with the new-onset seizure. Neurology consult was performed, but found no focal neurological deficits. The diagnosis of massive pulmonary embolism was confirmed by echocardiography and pulmonary CT angiography. Alteplase and heparin with therapeutic dosage were started for the patient. After initiating treatment, patient’s dyspnea, arterial O2 saturation, and general condition were significantly improved. Echocardiography was repeated and showed a smaller right ventricle size and lower pulmonary artery pressure than the first echocardiography.


pulmonary thromboembolism; seizure; massive pulmonary embolism; thrombosis

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Ruggiero A, Screaton N. Imaging of acute and chronic thromboembolic disease: state of the art. Clin Radiol. 2017; 72(5):375-388.

Raymakers AJ, Mayo J, Marra CA, FitzGerald M. Diagnostic strategies incorporating computed tomography angiography for pulmonary embolism: a systematic review of cost-effectiveness analyses. J Thor Imag. 2014; 29(4):209-216.

Jaff MR, McMurtry MS, Archer SL, et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation. 2011; 123(16):1788-1830.

Alirezaei T, Sattari H, Irilouzadian R. Significant decrease in plasmad-dimer levels and mean platelet volume after a 3-month treatment with rosuvastatin in patients with venous thromboembolism. Clin Cardiol. 2022; 45(7):717-722.

Zuin M, Rigatelli G, Zuliani G, et al. Seizures as the first clinical manifestation of acute pulmonary embolism: an underestimate issue in neurocritical care. Neurol Sci. 2020; 41(6):1427-1436.

Fred HL, Yang M. Sudden loss of consciousness, dyspnea, and hypoxemia in a previously healthy young man. Circulation. 1995; 91(12):3017-3019.

Meyer MA. Seizure as the presenting sign for massive pulmonary embolism: Case report and review of the literature. Seizure. 2009; 18(1):76-78.

Marine JE, Goldhaber SZ. Pulmonary embolism presenting as seizures. Chest. 1997; 112(3):840-842.

Desai PV, Krepostman N, Collins M, et al. Neurological Complications of Pulmonary Embolism: a Literature Review. Curr Neurol Neurosci Rep. 2021; 21(10):59.

Volz EE, Jasani N. Seizure as a presentation of pulmonary embolism. J Emerg Med. 2014; 46(1):e1-e4.

Giri J, Sista AK, Weinberg I, et al. Interventional Therapies for Acute Pulmonary Embolism: Current Status and Principles for the Development of Novel Evidence: A Scientific Statement From the American Heart Association. Circulation. 2019; 140(20):e774-e801.

Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Heart J. 2020; 41(4):543-603.

Alirezaei T, Mahboubi‐Fooladi Z, Irilouzadian R, et al. CHA2DS2‐VASc and PESI scores are associated with right ventricular dysfunction on computed tomography pulmonary angiography in patients with acute pulmonary thromboembolism. Clin Cardiol. 2022; 45(2):224-230.

DOI: http://dx.doi.org/10.22551/2022.37.0904.10219

Copyright (c) 2022 Toktam Alirezaei, SeyedehFatemeh Mousavi, Hamed Hesami

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ISSN: 2360-6975