Anvesh Jackson1, Simon Bower2, Udaya Seneviratne3. 1. Department of Neuroscience, Monash Medical Centre, Clayton, Victoria, Australia. Electronic address: anvesh.jackson@monashhealth.org. 2. Department of Neuroscience, Monash Medical Centre, Clayton, Victoria, Australia. Electronic address: simon.bower@monashhealth.org. 3. Department of Neuroscience, Monash Medical Centre, Clayton, Victoria, Australia; Department of Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: udaya.seneviratne@monash.edu.
Abstract
PURPOSE: Cardiac asystole is known to cause clinical manifestations mimicking seizures. The recognition of this uncommon phenomenon is important to expedite appropriate clinical intervention and avoid unnecessary morbidity as well as potential mortality. METHODS: We retrospectively reviewed video-electroencephalographic (EEG) records from January 2008 to December 2013 for relevant cases. RESULTS: We identified four patients who experienced nine events of asystole accompanied by seizure-like activity captured on video-EEG. None had evidence of epilepsy on video-EEG. Semiological features of captured clinical events included aura, automatisms, generalized tonic activity and focal as well as generalized myoclonus. No patient had generalized tonic-clonic seizures. A peculiar rapid breathing pattern was seen preceding the onset of asystole. General pallor was observed during asystole, followed by flushing on recovery. Seizure-like semiology was observed in three stages; pre-asystole, during asystole and after resumption of cardiac rhythm. The EEG demonstrated generalized slowing followed by generalized suppression during asystole and generalized slowing again on resumption of sinus rhythm ("slow-flat-slow" pattern). All patients had dual-chamber pacemakers implanted. On follow-up, they have remained symptom-free without antiepileptic medications. CONCLUSIONS: Cardiac asystole can be associated with features closely mimicking seizures. Recurrent episodes of cardiac asystole can be stereotypical in a given patient. There are some diagnostic clues in semiology. Crown
PURPOSE:Cardiac asystole is known to cause clinical manifestations mimicking seizures. The recognition of this uncommon phenomenon is important to expedite appropriate clinical intervention and avoid unnecessary morbidity as well as potential mortality. METHODS: We retrospectively reviewed video-electroencephalographic (EEG) records from January 2008 to December 2013 for relevant cases. RESULTS: We identified four patients who experienced nine events of asystole accompanied by seizure-like activity captured on video-EEG. None had evidence of epilepsy on video-EEG. Semiological features of captured clinical events included aura, automatisms, generalized tonic activity and focal as well as generalized myoclonus. No patient had generalized tonic-clonic seizures. A peculiar rapid breathing pattern was seen preceding the onset of asystole. General pallor was observed during asystole, followed by flushing on recovery. Seizure-like semiology was observed in three stages; pre-asystole, during asystole and after resumption of cardiac rhythm. The EEG demonstrated generalized slowing followed by generalized suppression during asystole and generalized slowing again on resumption of sinus rhythm ("slow-flat-slow" pattern). All patients had dual-chamber pacemakers implanted. On follow-up, they have remained symptom-free without antiepileptic medications. CONCLUSIONS:Cardiac asystole can be associated with features closely mimicking seizures. Recurrent episodes of cardiac asystole can be stereotypical in a given patient. There are some diagnostic clues in semiology. Crown
Authors: Jon M Dickson; Louise H Taylor; Jane Shewan; Trevor Baldwin; Richard A Grünewald; Markus Reuber Journal: BMJ Open Date: 2016-02-23 Impact factor: 2.692