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Spontaneous polymorphic ventricular tachycardia recorded during an electroencephalogram in a patient with apparent epilepsy
  1. O Paziaud,
  2. O Piot,
  3. N Elbaz

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A 60 year old woman presented to the emergency department after four episodes of seizure. She had already experienced two repeated episodes during the past year before admission. The physical examination, including a complete neurological examination, was normal. Despite an intravenous infusion of clonazepam, another episode of seizure occurred with unresponsiveness and tonic–clonic movements followed by post-ictal confusion. The computed tomography of the head was normal. An electroencephalogram was then performed. During this recording, another episode of seizure occurred. As shown in the panel below, a polymorphic ventricular tachycardia (VT) started before any change of the electroencephalogram. The electrocerebral activity then showed an increasing amplitude followed at 14 seconds by a flattening and slowing activity (below). The polymorphic VT spontaneously resumed after 56 seconds (right panel). A long QT syndrome was diagnosed. β Blocker treatment was started and a defibrillator implanted.

This recording demonstrates that a proven seizure can be related to a spontaneous polymorphic VT. This reinforces the idea that cardiac issues should be systematically considered in patients with a diagnosis of epilepsy remaining uncertain.

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Occurrence of a spontaneous polymorphic VT during the recording of the electroencephalogram. Note that for better clarity, only six derivations of EEG are displayed, as changes in amplitude and activity were similar in 16.

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Spontaneous reduction of polymorphic VT after 56 seconds.