Seizure as the presenting sign for massive pulmonary embolism: case report and review of the literature.

A 50-year-old male with sudden syncope and witnessed seizure activity was discovered to have pulmonary emboli. Although he denied shortness of breath, d-dimer testing was positive and a ventilation-perfusion scan was positive for bilateral pulmonary emboli; cardiac ECHO also confirmed elevated right ventricular pressures. The literature on this unusual presentation for seizures as the initial manifestation of pulmonary embolism is reviewed. Clinicians need to be more aware that pulmonary embolism is important to consider within the differential diagnosis for unexplained new onset of seizure activity.