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Rather Unusual Cause of Seizures

Published:December 22, 2020DOI:https://doi.org/10.1016/j.amjmed.2020.11.015
      A 73-year-old man with a history of hypertension, type 2 diabetes, atrial fibrillation, and gastroesophageal reflux disease was evaluated for recent episodes of “spells” of aphasia. He was taking metoprolol succinate, diltiazem, apixaban, atorvastatin, and omeprazole. Physical examination and a detailed neurological examination were normal. He underwent magnetic resonance angiogram of the brain and neck, which was unremarkable. Awake and sleep electroencephalogram was also normal. Echocardiogram revealed a normal ejection fraction (63%) without atrial mass or clot. Following evaluation, he was involved in a motor vehicle accident, presumably due to loss of consciousness while driving, resulting in a fractured L1 vertebra. When seen in the Emergency Department, he was noted to be in a postictal state. A diagnosis of probable focal seizure disorder was made. He received a loading dose of levetiracetam and was placed on a maintenance dose at dismissal.
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