DOI: 10.1097/LGT.0b013e318181fb24
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PMID: 19098607
Issn Print: 1089-2591
Publication Date: 2009/01/01
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Excerpt
Seizures of varying etiologies may present in a gynecologic setting, and appropriate management depends on the correct diagnosis. Seizures have been reported with lidocaine administration to the oral mucosa [1], and vaginal mucosa is histologically similar [2]. We report the differential diagnosis of a seizure after lidocaine administration in a woman with vestibulodynia.
A 47-year-old postmenopausal woman was referred to our clinic for vestibulodynia. She had no personal or medical history of seizure disorders, but reported one instance of faintness during wisdom tooth removal. After demonstrating tender areas to the patient using a handheld mirror, the physician applied approximately 2 mL of 2% lidocaine hydrochloride jelly outside the hymenal ring. Within approximately 3 minutes, the patient experienced one generalized, tonic seizure that lasted for no more than 30 seconds and ended spontaneously. After a short postictal state, the patient did not experience any additional seizures.
Although the timing of seizure onset and lidocaine administration suggested a relationship, the 40-mg dose would not have produced sufficient blood concentrations (1-5 μg/mL) to induce a seizure [1]. Nor is it likely that the patient experienced generalized epilepsy because of her negative history and the absence of aura, prolonged tonic-clonic movements, or incontinence. Vasovagal syncope was the probable cause because she became lightheaded after arising from a lying position and experienced a brief loss of consciousness with a few myoclonic jerks. Clinicians should be aware of the subtle differences between types of seizure activity to prevent misdiagnosis and improper treatment.
