From the Guidelines
Elevated troponin is common after various conditions, including acute neurological diseases such as tonic-clonic seizures.
Conditions that Elevate Troponin
- Acute neurological disease, including stroke or subarachnoid haemorrhage, can cause elevated troponin levels 1
- Other conditions such as cardiac contusion, congestive heart failure, aortic dissection, and pulmonary embolism can also lead to elevated troponin levels 1
Troponin Elevation in Seizures
While the provided evidence does not directly address the frequency of elevated troponin after tonic-clonic seizures, it does suggest that acute neurological diseases can cause troponin elevation 1
Key Points
- Elevated troponin levels are not exclusive to myocardial infarction and can be caused by various conditions, including acute neurological diseases 1
- The diagnosis of myocardial infarction requires evidence of myocardial ischemia, and an elevated troponin level alone is not sufficient for diagnosis 1
- High-sensitivity troponin assays are recommended for detecting cardiomyocyte injury, and elevations in troponin levels should be interpreted in the context of clinical presentation and other diagnostic findings 1
From the Research
Elevated Troponin after Tonic-Clonic Seizures
- Elevated troponin levels can occur after a generalized tonic-clonic (GTC) seizure, as reported in studies 2, 3, 4, 5.
- The frequency of elevated troponin levels after GTC seizures varies, with one study finding that 28.6% of patients had elevated cardiac troponin T (cTnT) levels 2, while another study found that 10% of patients had elevated cardiac troponin I (cTNI) and 26% had elevated high-sensitive troponin T (hsTNT) 4.
- Patients at risk for elevated troponin levels after GTC seizures include the elderly and those with cardiovascular risk factors, such as coronary heart disease (CHD) 2.
- The mechanism of elevated troponin levels after GTC seizures is thought to be related to demand ischemia during the sympathetic overactivity that accompanies a GTC seizure, resulting in minor ischemic cardiac injury 2.
- Elevated troponin levels after GTC seizures may not always indicate myocardial infarction, and alternative causes such as post-seizure and transient takotsubo cardiomyopathy should be considered 5.
- The use of more sensitive biomarkers, such as hsTNT, may suggest that signs of cardiac stress occur in about 25% of patients with GCS without apparent clinical symptoms 4.