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Emergency Department Presentation of a New-Onset Seizure

A Case Report

Miller, Benjamin J., PhD, ARNP, FNP-C, ACNPC, ENP-C

Section Editor(s): Ramponi, Denise R. DNP, FNP-C, ENP-BC, FAEN, FAANP, CEN; Column Editor

doi: 10.1097/TME.0000000000000217

A seizure is a symptom of brain dysfunction, resulting in 1.6 million emergency department visits each year. The evaluation of new seizures in the emergency department is a process looking for triggers of seizures such as toxins, mass lesions, or metabolic derangements. Maintaining a broad differential diagnosis is essential to prevent premature closure of the diagnostic evaluation. Timing of neurologic imaging and electroencephalogram depends on the clinical situation. In this case, a young woman presents with a “new-onset” seizure with subsequent elevation of white blood cells and serum lactate levels. Neurologic imaging identified a large dermoid cyst in the frontal lobe. We review how seizures can elevate the serum lactate distinguishing a general tonic–clonic seizure from pseudoseizures and how dermoid cysts can be implicated in seizures.

College of Nursing, Seattle University, Washington.

Corresponding Author: Benjamin J. Miller, PhD, ARNP, FNP-C, ACNPC, ENP-C, College of Nursing, Seattle University, 901 12th Ave, Garrand 301, Seattle, WA 98122 (

Disclosure: The author reports no conflicts of interest.

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