Focal-onset seizure due to left internal carotid artery dissection in the context of confounding hyperglycaemia.
Zachary James MoulderMonika KoselaM Ahtsham ZafarAbhinav JhaKarthik GopalAnmol PandeyPublished in: Oxford medical case reports (2022)
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.
Keyphrases
- contrast enhanced
- internal carotid artery
- magnetic resonance imaging
- computed tomography
- dual energy
- blood glucose
- middle cerebral artery
- magnetic resonance
- diffusion weighted imaging
- temporal lobe epilepsy
- image quality
- positron emission tomography
- resting state
- white matter
- healthcare
- pulmonary embolism
- type diabetes
- blood pressure
- functional connectivity
- optic nerve
- cerebral ischemia
- heat stress
- clinical decision support