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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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What causes seizures after surgery ?

Female 34 year old, 176-180 lbs, fibroid tumors, chronic sinusitis. 2 prior surgeries to remove nasal pollups. Third most recent surgery x 2 weeks ago to remove nasal pollups. Surgery went well, seeming normal recovery. However, developed two blood clots in r leg ( below the kne in calf area.) Blood clots were discovered a week following surgery. Immediatly started on Lovenox. 24 hours after beginning lovenox tx, exhibited siezure like symptoms, inclusing headache, aura, muscle spasm and slurred speech. Admitted to hospital, all ct scans and blood work were negative. Seizure symptoms decreased significantly following the 18 hours after the initial seizure/hospital admission. Seizures returned after about 5 hours later. Hospital did not discharge as the seizure persisted continously. Is there possibility that the seizures are side effect of surgery to remove sinus pollups? Speculated that it could be side effect of Levenox because she does not have bleeding in brain.
Thu, 12 Dec 2019
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Neurologist 's  Response
Hello,

There is an increased risk of seizures following anesthesia, but typically the individuals already has a risk of having seizures if they occur. It is highly unlikely that lovenox would cause seizures, unless as you said there was bleeding into the brain, but that could be seen with a CT scan or MRI. The symptoms you describe, although they can be seen in seizures, don't particularly strike me as such.

A typically seizure involves convulsions with loss of consciousness. The period after seizures however can present as you described. There are more focal seizures that again can show up as you describe. Continuous seizures would cause significant harm, most likely loss of consciousness as they often spread to involve the whole brain. In any case, an EEG should have been done on you to evaluate for true seizure activity, and if you haven't had one done, you definitely should.

The description of the symptoms could easily be due to a migraine as some types of migraines can actually result in neurological symptoms with confusion, slurred speech, weakness, vision loss, and numbness/tingling. I feel that this would be more likely, unless an EEG was done and it showed true seizure activity.

Surgeries can cause stress on the body which can result in both headaches and seizures. I don't think it is lovenox would cause either unless as you note there was bleeding in the brain. If an EEG was done and there is seizure activity, then she should be started on a seizure medication such as Keppra 750 mg by mouth twice a day.

If this is the case, then she has likely had a propensity for seizures, which was simply unmasked by the surgery. None them less an MRI with and without contrast with an epilepsy protocol (thin T2 cuts through the temporal lobes) should be obtained to evaluate for any lesions in the brain.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Janne Nissinen, Neurologist
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