Postictal Confusion as the Initial Presentation of Dilated Cardiomyopathy: A Case Report and Review of Literatures

Abstract

Acute dilated cardlomyopathy (DCM) is associated with an increased risk of left ventricular (LV) thrombus and subsequent thromboembolism diseases. Multiple sites of acute brain infarctions as the first manifestation of DCM had never been reported before. Here we report a 34-year-old man who presented generalized tonic clonic seizure and postictal confusion as the initial manifestation of acute DCM complicated with LV thrombus and multiple sites of acute brain infarction. This case highlights that physicians should have high alert to the underlying etiology of acute ischemic stroke (AIS) in young patients. Additional imaging modalities may be necessary to elucidate the nature of seizure and confirm the diagnosis of AIS. An early echocardiographic examination is necessary to justify the risk-benefit of the use of anti-coagulation or thrombolytic therapy. The presence of LV thrombus and seizure at the onset of stroke could be management dilemma of this patient.