Postictal bradyarrhythmia following an isolated seizure in a patient with left hemisphere stroke

摘要

Sudden death contributes significantly to mortality in patients with refractory epilepsy and acute stroke.1'2 Presently, our field has only a rudimentary understanding of the pathophysiology underlying these phenomena, and proposed substrates include lethal centrally mediated cardiac arrhythmias.A 73-year-old diabetic hypertensive woman with atrial fibrillation (not anticoagulated due to recent severe epistaxis) presented to our emergency ward for new onset slurred speech, drooling and difficulty producing words. On examination, she was agitated, hypertensive to 209/132, and in atrial fibrillation at a rate of 118. She displayed a predominantly receptive aphasia with dysarthria and right hemineglect, as well as right hemianopsia and a mild right hemiparesis. A noncontrast head computed tomography scan showed no hemorrhages or conspicuous hypodensities. Thrombolysis was deferred as the time of onset of symptoms was unknown. Presumed to have a left hemisphere embolic stroke, she was admitted to the neurointensive care unit and heparinized.