Postictal Confusion as the Initial Presentation of Dilated Cardiomyopathy: A Case Report and Review of Literatures

癲癇後意識混亂爲表現的擴大性心肌病變併多發性急性缺血性腦梗塞：病例報告及文獻回顧

何政軒(Cheng-Hsuan Ho) ； 林彥瑜(Yen-Yue Lin) ； 吳雅潔(Ya-Chieh Wu) ； 朱士傑(Shi-Jye Chu) ； 蔡適鴻(Shih-Hung Tsai)

《內科學誌》 21卷2期 (2010/04) Pp. 133-139

https://doi.org/10.6314/JIMT.2010.21(2).06

摘要

擴張性心肌病變易造成左心室的血栓進而發生栓塞徵候群，然以多發性急性缺血性腦梗塞併癲癇大發作及癲癇後意識混亂爲初期臨床表現則未被報導過。我們報告一位34歲男性，有左心室血栓以及同時併發多處急性腦血管阻塞，併發癲癇大發作。據文獻指出擴張性心肌病變患者易有左心室血栓，而且同時有更高產生血栓機會。年輕性腦中風的原因因地緣性以及年齡上的區別有明顯不同。急性缺血性腦梗塞發作七天內，有2~8%機會發生早期癲癇發作。臨床醫師首重在區分出癲癇後一過性麻痺與急性缺血性腦梗塞的不同，因爲前者是施打血栓溶解劑的絕對禁忌症。然而從臨床病史與電腦斷層上，兩者不易區分，建議配合灌流式電腦斷層、血管攝影、心臟超音波或核磁共振。如此才能判斷是否開始抗凝血或血栓溶解治療，且權衡長期使用雙重抗血小板或抗凝血劑治療可能造成出血體質之風險。

並列摘要

Acute dilated cardlomyopathy (DCM) is associated with an increased risk of left ventricular (LV) thrombus and subsequent thromboembolism diseases. Multiple sites of acute brain infarctions as the first manifestation of DCM had never been reported before. Here we report a 34-year-old man who presented generalized tonic clonic seizure and postictal confusion as the initial manifestation of acute DCM complicated with LV thrombus and multiple sites of acute brain infarction. This case highlights that physicians should have high alert to the underlying etiology of acute ischemic stroke (AIS) in young patients. Additional imaging modalities may be necessary to elucidate the nature of seizure and confirm the diagnosis of AIS. An early echocardiographic examination is necessary to justify the risk-benefit of the use of anti-coagulation or thrombolytic therapy. The presence of LV thrombus and seizure at the onset of stroke could be management dilemma of this patient.

並列關鍵字

Acute ischemic stroke ； Embolism ； Dilated cardlomyopathy ； Mural thrombus ； Seizure