Bokhari Syedah Saira, Hashmi Satwat
Department of Medicine, Aga Khan University, Karachi, Pakistan.
Department of Biological and Biomedical Sciences, Aga Khan University Hospital, Karachi, Pakistan.
BMJ Case Rep. 2016 Mar 23;2016:bcr2015214286. doi: 10.1136/bcr-2015-214286.
A 30-year-old woman presented to the emergency room with recurrent seizures for 5 days. She had been diagnosed with epilepsy 2 years previously but stopped treatment due to the side effects of her medications. She was now experiencing episodes every 15-30 min. While undergoing a brain MRI to investigate for structural central nervous system pathology, she experienced another episode, preceded by prodromal symptoms. Polymorphic ventricular tachycardia was noted during the event. Further investigation revealed a normal QT interval, normal electrolyte panel, normal coronaries and severe left ventricular systolic dysfunction. Cardiac MRI revealed non-ischaemic cardiomyopathy. The patient was managed with heart failure and antiarrhythmic medications and an implantable cardioverter defibrillator. She remained symptom free at 6-month follow-up. This case highlights the importance of differentiating between cardiogenic syncope and epilepsy and reiterates the importance of re-evaluating a diagnosis of epilepsy when presentation is atypical or symptoms are refractory.
一名30岁女性因反复癫痫发作5天就诊于急诊室。她2年前被诊断为癫痫，但因药物副作用而停止治疗。她现在每15 - 30分钟发作一次。在接受脑部MRI检查以排查中枢神经系统结构病变时，她在出现前驱症状后又发作了一次。发作期间记录到多形性室性心动过速。进一步检查显示QT间期正常、电解质指标正常、冠状动脉正常以及严重的左心室收缩功能障碍。心脏MRI显示为非缺血性心肌病。该患者接受了心力衰竭和抗心律失常药物治疗以及植入式心律转复除颤器治疗。6个月随访时她无症状。该病例强调了区分心源性晕厥和癫痫的重要性，并再次强调当表现不典型或症状难治时重新评估癫痫诊断的重要性。
