Elevated serum cardiac troponin I level in a patient after a grand mal seizure and with no evidence of cardiac disease.

The World Health Organization recognizes biochemical markers of myocardial injury as one of the three criteria for the diagnosis of acute myocardial infarction. We report the first case of elevated troponin I in a patient after a grand mal seizure in the hospital, with no evidence of myocardial infarction and no rhabdomyolysis. Cardiac catheterization and two-dimensional echocardiographic findings were normal. Four months later, the patient was readmitted, again having experienced a grand mal seizure. She was asymptomatic for cardiac disease in both instances. There was a temporal correlation between troponin I levels and seizures. Studies have shown that a troponin level above 3.5 ng/mL implies significant myocardial injury. Our patient had troponin I values as high as 5.5 ng/mL and 6.3 ng/mL. This case implies that troponin I can be significantly increased after a grand mal seizure, and with low clinical suspicion for myocardial injury this abnormality should be disregarded.