A Case of First Epileptic Seizure Diagnosed with Top of the Basilar Syndrome

Submit Manuscript | http://medcraveonline.com irritation was noted. Her hemoglobin level was low (10.6 g/ dL (normal range 12-14 g/dL)). Her electrocardiogram showed normal sinus rhythm. Her brain CT and diffusion MRI were both normal. She was monitored at postictal period at the emergency service. Phenytoin infusion was started at a loading dose of 20 mg/ kg to suppress seizure activity. As she continued to have persistent alteration of consciousness, anisocoria, and delayed motor response to painful stimuli without any sign of improvement, neuroimaging tests were repeated at the same day. Control brain diffusion MRI B1000 sections showed hyperintense areas, and corresponding hypointense areas on ADC, consistent with acute infarction in bilateral cerebellar, bilateral mesencephalon, pons, and right thalamic area (Figure 1). Having been diagnosed with TOB-S, the patient was admitted to intensive care unit. She was administered acetylsalicylic acid, low molecular weight heparin, and levatirecetam 2x1000 mg as a maintenance dose. She had no recurrent seizure episodes. Her electroencephalogram did not show any active epileptiform pattern. On 21st day of admission she was intubated and connected to mechanical ventilation due to respiratory failure. However, owing to impaired creatinine clearance, no CT angiography, MR angiography, or carotidvertebral DSA study could be done. The patient died from cardiac arrest on 31st day of admission.