Vertebral Artery Dissection Associated with Generalized Convulsive Seizures: A Case Report
An otherwise healthy 46-year-old male engineer, with juvenile myoclonic epilepsy, was admitted to our department following convulsive seizures 1 month after discontinuation of lamotrigine. He was diagnosed with juvenile myoclonic epilepsy at the age of 39 after having 3 generalized convulsive seizures over 3 months. An EEG and brain CT were both normal. He was started on valproic acid 900 mg and was shifted to lamotrigine 200 mg daily 3 years later. After a 5-year period without seizures, lamotrigine was slowly tapered off and the patient completely stopped the intake 1 month before the present admission. He was admitted to hospital with a right-sided hemiparesis with Babinski sign, a right-sided central facial palsy and an ataxic finger-nose test on the left side, which developed following a generalized convulsive seizure 1 day prior to admission. He had no neurological or other complaints up to the seizure. Brain CT was normal, but an MRI scan showed an infarct in the left cerebellar hemisphere (fig. ) and a left-sided pontine infarction (fig. ). Subsequent MR angiography showed a right VAD (fig. ).\nIn addition, the blood samples for kidney and liver function, haemoglobin and coagulation factors were all in the normal range of reference. However, there was a high leucocyte count with an overabundance of neutrophils. Moreover, the patient's blood pressure at the time of admission was normal (127/87 mm Hg), and he was afebrile. The patient was started on heparin and the oral anticoagulant warfarin, which he continued for 6 months (from January 10 until June 21). The treatment with lamotrigine was also resumed. Recovery of neurologic function was excellent, and he was discharged after 14 days. A control MR angiography 6 months later showed a normal vertebral artery (fig. ). The patient still continued treatment with aspirin and dipyridamole.