Differential Diagnosis for Seizure-Like Activity with Massive PE
- Single Most Likely Diagnosis
- Pulmonary Embolism (PE) with syncope or seizure-like activity due to hypoxia: This is the most likely diagnosis given the mention of "massive PE." A large pulmonary embolism can lead to sudden onset of symptoms including syncope or seizure-like activity due to the acute reduction in cardiac output and subsequent cerebral hypoxia.
- Other Likely Diagnoses
- Seizure disorder with coincidental PE: It's possible that the patient has a pre-existing seizure disorder and the PE is an unrelated finding. The seizure could be due to various causes such as epilepsy, and the PE could be a separate condition.
- Hypoxic seizure due to other causes: Other conditions leading to hypoxia, such as acute respiratory distress syndrome (ARDS), status asthmaticus, or cardiac arrest, could also cause seizure-like activity.
- Do Not Miss Diagnoses
- Cardiac arrest: Although less likely given the specific mention of "seizure-like activity," cardiac arrest is a critical condition that must be considered, especially if the patient had a witnessed collapse or if there's evidence of cardiac dysfunction.
- Aortic dissection: This is a life-threatening condition that could present with sudden onset of symptoms including syncope or seizure-like activity due to involvement of the aortic arch and subsequent cerebral hypoperfusion.
- Status epilepticus: Prolonged seizure activity can lead to significant morbidity and mortality if not promptly treated.
- Rare Diagnoses
- Cerebral venous sinus thrombosis: Although rare, this condition can cause seizures and could potentially be associated with PE, especially in patients with hypercoagulable states.
- Fat embolism syndrome: Typically seen after long bone fractures, this condition can cause a variety of symptoms including seizures and respiratory distress, and could be considered in the appropriate clinical context.