Man With New-Onset Seizure

Abstract

A 39-year-old man presented to the emergency department with a new-onset generalized tonic-clonic seizure. On assessment, he was lucid and complained of mild head fullness and transient numbness of both lower extremities. His blood pressure was 108/66 mm Hg, and the physical examination, blood work, chest radiography, and brain computed tomography (CT) were normal. After some time, he developed differential blood pressures in his arms (98/52 mm Hg versus 76/40 mm Hg) without any other symptoms. The emergency physician performed bedside ultrasonography to rule out vascular injury and observed an intimal flap with thrombus formation in the false lumen of the left common carotid artery (Figure 1, Video E1, Video E2; available at http://www.annemergmed.com) as well as aortic root dilation of 4.8 cm.