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A first seizure episode
  1. Thomas MacMahon
  1. Tallaght University Hospital, Dublin, Ireland
  1. Correspondence to Dr Thomas MacMahon, Tallaght University Hospital, Dublin, Ireland; tmacmahon{at}

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Clinical introduction

A middle-aged man is brought to your ED following a self-limiting generalised tonic–clonic seizure. He is a smoker, with a history of chronic obstructive pulmonary disease (COPD) and peripheral vascular disease, but no previous seizures. He is on aspirin and clopidogrel.

On assessment, you see no evidence of trauma. He is confused, with a Glasgow Coma Scale 14 (E4, V4, M6) and mild global limb weakness but no focal neurology. He is newly hypertensive (210/140 mm Hg). His …

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  • Contributors TM is the sole author of this work and designed, wrote and edited the submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.