Massive Pulmonary Embolism Presenting as Recurrent Seizures: Successful Thrombolysis and Thrombectomy Guided by Clinical Suspicion

Massive pulmonary embolism (PE) with obstructive shock is a life-threatening condition associated with poor prognosis, primarily due to diagnostic challenges. Clinical presentation is often nonspecific, beyond the classic signs of shock, and confounding factors, such as seizures secondary to cerebral hypoperfusion, as observed in this case, may further obscure the diagnosis. We report the case of a 54-year-old male patient brought to the ED by the mobile emergency and resuscitation service following recurrent seizures associated with refractory hypotension. Given the rapid clinical deterioration and multiple cardiac arrests, an underlying cause was urgently sought. After ruling out common etiologies such as sepsis and acute coronary syndrome, massive PE was strongly suspected based on bedside point-of-care echocardiography findings, elevated D-dimer levels, and high clinical suspicion. Systemic thrombolysis (alteplase) was administered directly in the ED, leading to hemodynamic stabilization. The diagnosis was later confirmed via contrast-enhanced thoracic CT, and the patient subsequently underwent mechanical thrombectomy, resulting in complete recovery. He was extubated and regained full consciousness on the same day. This case illustrates how timely management guided by strong clinical suspicion can lead to full recovery without sequelae. It also emphasizes the critical importance of minimizing no-flow time to achieve optimal outcomes.