Abdominal CT scan for recurrent seizures

Excerpt

A 34-year-old man was referred to the emergency department for generalized tonicoclonic seizures. No drug, medication, or medical prescription were found. Heart rate was 126/min, blood pressure 192/109 mmHg, and temperature was 38.2 °C. Physical examination revealed a comatose patient with adapted response to noxious stimulation. Reflexes were present; plantar responses were downward. Both pupils were equally dilated. Laboratory analysis showed increased blood lactate level (10 mmol/L). Fifteen minutes after arrival, the patient experienced three new generalized seizures for which intravenous clonazepam and phenobarbital were administered. The trachea had to be intubated, and the patient was placed under mechanical ventilation immediately thereafter; transient major electrographic changes were noted (Fig. 1). Toxicological urine screening was positive for cocaine. CT scan of the head was normal but abdominal scanning showed multiple capsule images in the stomach, ileon, colon, and rectum suggesting “body packing” (Fig. 2). Eight capsules could be removed after rectal examination. The extraction of the 56 other ones required laparotomy and enterotomy. One of the removed capsule was torn which explained the initial seizures, adrenergic syndrome, and probable coronary spasm. The patient had an uneventful course thereafter.

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