Abstract
Cardiac troponin concentrations are important sensitive and specific markers for myocardial injury in clinical medicine. Troponin (TnT) elevations have been noted in some series in the setting of acute neurologic disease. We have previously reported that solitary seizures do not evoke elevations in TnT. The importance of this negative finding is exemplified by a patient who arrived at our clinic following a new onset seizure and in whom the cardiac TnT level was observed to rise. Triggered by this observation and by the knowledge that seizures alone would not do this, a subsequent targeted cardiologic workup documented what was believed to be an extension of a previously unrecognized myocardial infarction, with a seizure as its clinical presentation. Elevations of troponin should not be considered to be due to isolated seizures. This case illustrates the importance of having data concerning the response of troponin in various emergency and clinical situations.
Keywords: troponin, Seizures, medical emergencies, myocardial infarction, pulmonary emboli
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References
- 1. The World Health Report 2001 : Mental Health: New Understanding: New Hope: Chapter 2. Burden of Mental and Behavioural Disorders: Epilepsy
- 2. Zaidi A, Clough P, Cooper P, Scheepers B, Fitzpatrick A, Misdiagnosis of epilepsy: Many seizure‐like attacks have a cardiovascular cause. J Am Coll Cardiol 2000; 36: 181–184 [DOI] [PubMed] [Google Scholar]
- 3. Devinsky O, Price BH, Cohen SI: Cardiac manifestations of complex partial seizures. Am J Med 1986; 80 (2): 195–202 [DOI] [PubMed] [Google Scholar]
- 4. Dixit S, Castle M, Velu RP, Swisher L, Hodge C, Jaffe AS: Cardiac involvement in patients with acute neurologic disease. Arch Intern Med 2000; 160: 3153–3158 [DOI] [PubMed] [Google Scholar]
- 5. Adams JE, Bodor GS, Davila‐Roman VG: Cardiac troponin I: A marker with high specificity for cardiac injury. Circulation 1993; 88: 101–106 [DOI] [PubMed] [Google Scholar]
- 6. Tigaran S, Ravkilde J, Molgaard H, Dam M: Importance of cardiac troponin T and creatine kinase isoenzyme MB mass as serological markers of myocardial injury in epilepsy. Epilepsia 2000; 41 (suppl)S85 [Google Scholar]
- 7. Woodruff BK, Britton JW, Tigaran S, Cascino GD, Burritt MF, McConnell JP, Ravkilde J, Molgaard H, Andreasen F, Dam M, Jaffe AS: Cardiac troponin levels following monitored epileptic seizures. Neurology 2003; 60 (10): 1690–1692 [DOI] [PubMed] [Google Scholar]
- 8. Tigaran T, Molgaard H, McClelland R, Dam M, Jaffe AS: A potential cardiovascular mechanism for sudden unexplained death in epilepsy (SUDEP). Neurology 2003; 60 (3): 492–495 [DOI] [PubMed] [Google Scholar]
- 9. Carlson RJ, Navone A, McConnell JP, Burritt M, Castle MC, Grill D, Jaffe AS: Effect of myocardial ischemia on cardiac troponin I and T. Am J Cardiol 2002; 89: 224–226 [DOI] [PubMed] [Google Scholar]
- 10. Jaffe AS, Ravkilde J, Roberts R, Naslund U, Apple FS, Galvani M, Katus H: It's time for a change to a troponin standard. Circulation 2000; 102: 1216–1220 [DOI] [PubMed] [Google Scholar]
- 11. Giannitsis E, Muller‐Bardorff M, Kurowski V, Weidtmann B, Wiegand U, Kampmann M, Katus HA: Independent prognostic value of cardiac troponin T in patients with confirmed pulmonary embolism. Circulation 2000; 102: 211–217 [DOI] [PubMed] [Google Scholar]
- 12. Bybee KA, Prasad A, Barsness GW, Lerman A, Jaffe AS, Murphy JG, Wright RS, Rihal CS: Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol 2004; 94 (3): 343–346 [DOI] [PubMed] [Google Scholar]