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01-06-2020 | Acute Pulmonary Embolism | Review Article

Seizures as the first clinical manifestation of acute pulmonary embolism: an underestimate issue in neurocritical care

Authors: Marco Zuin, Gianluca Rigatelli, Giovanni Zuliani, Alessandro Adami, Pietro Zonzin, Loris Roncon

Published in: Neurological Sciences | Issue 6/2020

Abstract

Background

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.

Methods

After screening 258 articles in PubMed, Scopus, Cochrane Library, and Google Scholar databases, we identified 16 case reports meeting the inclusion criteria.

Results

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.

Conclusions

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.

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Title: Seizures as the first clinical manifestation of acute pulmonary embolism: an underestimate issue in neurocritical care
Authors: Marco Zuin
Gianluca Rigatelli
Giovanni Zuliani
Alessandro Adami
Pietro Zonzin
Loris Roncon
Publication date: 01-06-2020
Publisher: Springer International Publishing
Keywords: Acute Pulmonary Embolism
Acute Pulmonary Embolism
Acute Pulmonary Embolism
Electroencephalography
CT Angiography
Published in: Neurological Sciences / Issue 6/2020
Print ISSN: 1590-1874
Electronic ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-020-04275-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Seizures as the first clinical manifestation of acute pulmonary embolism: an underestimate issue in neurocritical care

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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