School of Medicine, University of Ferrara, Ferrara, Italy.
Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy.
Neurol Sci. 2020 Jun;41(6):1427-1436. doi: 10.1007/s10072-020-04275-y. Epub 2020 Feb 10.
The aim of the present review is to analyze the clinical characteristics of patients with acute pulmonary embolism (PE) which seizures were the first clinical manifestation of the disease.
After screening 258 articles in PubMed, Scopus, Cochrane Library, and Google Scholar databases, we identified 16 case reports meeting the inclusion criteria.
The mean age of the population was 48.4 ± 19.8 years (9 males and 7 females). About three of four patients (68.7%) were hemodynamically stable at admission, having a systolic blood pressure > 90 mmHg. Intriguingly, the doubt of acute PE was based on clinical suspicion or on instrumental findings in 62.5% and 18.7% of patients, respectively. In 3 subjects (18.7%), the acute cardiovascular disease was not suspected. Half of patients had an unremarkable previous medical history while neurological comorbidities were present in 4 patients (25.0%). During seizures, a transient loss of consciousness (TLOC) was reported in 6 cases. Seizures were retrospectively classified according to the 2017 ILAE classification, whenever possible. A focal and generalized onset was reported in 37.5% and 50% of cases, respectively, in 12.5% of patient's data that were insufficient to classify the events. The mean number of seizure episodes in the population enrolled was 2.0 ± 1.1. Mortality rate was 54.5% but one investigation did not report the patient's outcome.
The relationship between seizures and acute PE is probably underrecognized. Identifying patients that have a high probability of acute PE is fundamental to avoid any treatment delay and ameliorate their outcomes.
本综述旨在分析以癫痫发作为首发临床表现的急性肺栓塞（PE）患者的临床特征。
在 PubMed、Scopus、Cochrane 图书馆和 Google Scholar 数据库中筛选出 258 篇文章后，我们确定了符合纳入标准的 16 例病例报告。
人群的平均年龄为 48.4±19.8 岁（9 名男性和 7 名女性）。约四分之三的患者（68.7%）在入院时血流动力学稳定，收缩压>90mmHg。有趣的是，62.5%和 18.7%的患者分别基于临床怀疑或仪器检查结果怀疑急性 PE。在 3 名患者（18.7%）中，未怀疑急性心血管疾病。半数患者既往病史无明显异常，4 名患者（25.0%）存在神经系统合并症。在癫痫发作期间，6 例报告有短暂意识丧失（TLOC）。在可能的情况下，根据 2017 年 ILAE 分类回顾性地对癫痫发作进行分类。12.5%的患者数据不足以对事件进行分类，分别有 37.5%和 50%的病例报告为局灶性和全面性发作。入组人群的癫痫发作次数平均为 2.0±1.1 次。死亡率为 54.5%，但有一项研究未报告患者的结局。
癫痫发作与急性 PE 之间的关系可能未被充分认识。识别出具有急性 PE 高概率的患者对于避免任何治疗延误和改善其结局至关重要。
