Basilar artery occlusion presenting as a tonic-clonic seizure.

A 53 year old man with no history of epilepsy was admitted to the emergency department with complaints of vertigo, nausea and a single episode of vomiting. On neurologic examination eye movements were intact, there was no nystagmus or pyramidal signs, and instability of gait was noted. On computed tomography without contrast media a hypodense lesion was observed on the right cerebellum [Figure A]. Two days after admission the patient became confused. Several minutes later s troke-associated seizures are usually due to ischemic involvement of the cerebral cortex or intracerebral hemorrhage [1]. Cases of subcortical lesions inducing stroke are less common but have been described [2]. Non-epileptic involuntary movements of the arms and legs due to ischemic lesions in the brainstem have also been reported [3]. On the other hand there are a few reports of seizures associated with ischemic lesions of the brainstem. The pathophysiology and mechanism of the staff noticed vocalization followed by loss of consciousness and tonic-clonic movements with small amplitude in all four limbs. The presentation was seen by a neurologist who interpreted it as generalized tonic-clonic seizure, and since the condition continued for several minutes, status epilepticus was suspected. Intravenous phenytoin was administered with good seizure control at the end of the loading dose. Bedside monitor electroencephalogram performed half an hour after the movements stopped showed no epileptic activity. Urgent CT showed no hemorrhage or signs of new stroke. Two hours from seizure onset, while the patient was regaining consciousness, right hemiplegia, right gaze limitation and Babinsky sign on the right were observed. vertebrobasilar disease, stroke, status epilepticus, seizure