A 50-Year-Old Woman with Recurrent Generalised Seizures

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A 50-Year-Old Woman with Recurrent Generalised Seizures

Public Library of Science
DOI: 10.1371/journal.pmed.0050186
  • Neuroscience
  • Endocrinology
  • Neurology
  • Emergency Medicine
  • Neurological Disorders
  • Learning Forum
  • Diabetes And Endocrinology
  • Critical Care And Emergency Medicine
  • Critical Care / Intensive Care
  • Epilepsy And Seizures


plme-05-09-04-L.pdf PLoS Medicine | www.plosmedicine.org 1343 September 2008 | Volume 5 | Issue 9 | e186 Learning Forum D E S C R I P T I O N O F C A S E A50-year-old woman presented in May 2006 with recurrent generalised convulsions. She had a history of hypertension treated with indapamide, but was otherwise well. Her older sister and mother were known to have thyroid disease. She did not have any history of chronic alcohol use nor any recent history of head injury. The patient had never lived outside of Hong Kong. Prior to admission, she was taken to her general practitioner by her family for gradual onset of decreased alertness, cognitive decline, and reduced verbal communication, which worsened over the course of one week. She was found to have hypothyroidism with TSH (thyroid stimulating hormone) 52.3 mIU/l (normal range 0.47–4.68 mIU/l) and free T4 4.2 pmol/l (normal range 10.0–28.2 pmol/l), and was started on thyroxine replacement. Four days later, she developed two generalised seizures within three days and was admitted into hospital. She was afebrile and had no focal neurological signs on examination. Baseline investigations, including electrolytes, liver function tests, calcium, and phosphate, were normal. Random plasma glucose was 5.7 mmol/l. Magnetic resonance imaging (MRI) of brain was unremarkable. She was subsequently transferred to our hospital for further management. On admission, she was afebrile and had a series of seizures over a period of five hours without regaining full consciousness in between seizures. The patient was given intravenous diazepam and phenytoin, and was intubated and transferred to the intensive care unit. What Was Our Differential Diagnosis at This Stage? The patient presented with several days’ history of decreased consciousness, followed by acute symptomatic seizures. The differential diagnosis of someone with a subacute encephalopathy is wide, and possible causes are listed in Box 1. These include met

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