All Journals from Rohan Sajeev Wijesurendra
Abstract
Some forms of focal epilepsy, including temporal lobe epilepsy, are rarely associated with ictal bradycardia and sinus node arrest. We report a case of a previously healthy man presenting with syncope in whom telemetry revealed sinus arrest. Initial treatment was with permanent pacemaker implantation and it was only following a subsequent grand mal seizure that other symptoms suggestive of temporal lobe epilepsy were documented. Anti-epileptic medication was subsequently commenced with resolution of all symptoms. There are few previously reported cases of syncope and documented sinus node arrest as the presenting feature of temporal lobe epilepsy.
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A 40 year old previously fit bank executive of Cypriot origin presented to the acute medical take with insidious onset frontal and vertex headaches with features suggesting raised intracranial pressure. He had been under investigation in the outpatient department after developing multiple erythematous lesions on his legs, associated with malaise, occasional mouth ulcers and episodic sweats.
Case Outcome
The patient was anti-coagulated with low molecular weight heparin and then warfarin. He was also commenced on a reducing course of prednisolone. Symptoms and signs resolved within two weeks, and this was accompanied by normalisation of inflammatory markers. He remains clinically well and is now on methotrexate.