DOI: 10.36347/sjmcr.2017.v05i11.031

Pages: 792-794

A 69-year-old man returning home in a car driven by his wife after visiting our hospital due to complications of infection from an operation suddenly lost consciousness. He had right hemiparesis due to a brain stem infarction by atrial fibrillation at 58 years of age. When medical staff checked him at the front of the hospital, he had right tonic convulsion and was comatose. He was in a deep coma, and his systolic blood pressure was 168/116 mmHg, heart rate 96 beats per minute, respiratory rate 30 breaths per minute and SpO2 level 100% under room air. He received anti-convulsant. Electrocardiogram showed atrial fibrillation, and chest roentgen and cardiac sonography findings were negative. Head computed tomography (CT) revealed an old cerebral infarction at the brain stem. As he remained in a coma, further examinations using head magnetic resonance imaging (MRI) were performed. MRI demonstrated left fronto-temporo-parietal ischemia, and MR angiography revealed occlusion of the left middle cerebral artery. He underwent urgent aspiration thrombectomy, but cerebral ischemia developed into infarction. He was transported to another medical facility for rehabilitation. We herein report a rare case of convulsion as the initial sign of acute cerebral ischemia in an adult. A pre-existing inflammatory condition or brain stem infraction may have affected the rare occurrence of convulsion preceding cerebral ischemia in the present patient. Further studies are warranted to determine whether or not a patient with their first convulsion needs to receive urgent MRI after the confirmation of no significant lesions on CT.