Non-convulsive seizure clustering misdiagnosed as vertebrobasilar insufficiency

Yu-Shiue Chen; Tsang-Shan Chen; Chin-Wei Huang

doi:10.1016/j.heliyon.2020.e05376

Non-convulsive seizure clustering misdiagnosed as vertebrobasilar insufficiency

Heliyon. 2020 Nov 6;6(11):e05376. doi: 10.1016/j.heliyon.2020.e05376. eCollection 2020 Nov.

Authors

Yu-Shiue Chen¹, Tsang-Shan Chen², Chin-Wei Huang¹

Affiliations

¹ Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
² Department of Neurology, Tainan Sin-Lau Hospital, Tainan, Taiwan.

Abstract

Diagnosing non-convulsive seizures (NCSs) is a great challenge for most clinicians due to a wide spectrum of clinical presentations. The complexity of the disease course usually results in a delayed diagnosis or misdiagnosis so that timely and appropriate treatment is not given. Herein, we report a case with NCSs misdiagnosed as vertebrobasilar insufficiency (VBI), in which the patient suffered from episodes of prominent dizziness, vertigo, becoming transfixed, and worsening response within a day. Brain magnetic resonance image findings were unremarkable, however electroencephalography (EEG) showed rhythmic epileptiform discharges that appeared to originate from the right frontal area with ipsilateral hemispheric involvement. We prescribed intravenous valproate and the seizures ceased. Few studies have reported a patient with NCS misdiagnosed with VBI, a very different entity. It is thus important that clinicians should be aware of the trivial symptoms of NCSs, and to consider implementing early EEG studies and anti-epileptic drug therapy.

Keywords: Clinical research; Internal medicine; Neurology; Neuroscience nervous system; Nonconvulsive seizure; Seizure; Vertebrobasilar insufficiency.

Publication types

Case Reports