This report presents a case of grand mal seizure (convulsion), hyperthermia, coma and recovery immediately in a 19-year old woman who ingested 10 ecstasy tablets. The report includes an assessment of cerebral blood flow 20 and 49 days after ecstasy use. It is notable that the patient was asthmatic and used medication to control her asthma, and she had a history of pre-existing mild head trauma and "collapse." The seizure occurred 4 h after ingesting 10 ecstasy tablets. On admission, body temperature was 40 deg C, and the patient had rapid heartbeat and breathing (tachycardia and tachypnea). Urinalysis was positive for "amphetamines" and opiates, with positive opiate test assumed to be a false positive the result a drug contaminant. Chest X-rays showed an abnormality that disappeared 2 days later, and laboratory tests indicated transient mild renal insufficiency. On the second day of admission, the patient was awake and oriented, but had panic attacks and experienced disturbing hallucinations. The patient no longer had an elevated heart rate on the third day of admission. A neurological examination performed on the fifth day showed retrograde amnesia (inability to remember events prior to convulsion), general memory loss, dissimulation (unspecified; either denying drug use or confabulating), and expressions or feelings of helplessness. Neurological examination 22 days post-drug noted continued amnesia, irritability ("crankiness"), fatigue, lack of appetite, "slowness of thinking," and pyramidal signs on the right upper limb and exaggerated bilateral patella (knee cap) reflexes. Because of frontal theta activity (brain wave detected via electroencephalography, or EEG) and short-duration generalized theta groups with embedded sharp waves (associated with seizures or epilepsy), the patient was treated with valproate (an anticonvulsant). By 41 days after admission, the patient had improved, with reduced amnesia and improved (though not normal) reflexes, but with occasional sharp waves in EEG that led doctors to increase valproate dosage. Single photon emission computed tomography (SPECT) with [99Tc]-hexamethylpropyleneamine oxime (THMPAO) was performed 20 days post-drug and again 49 days post-drug (29 days after initial SPECT recording). The first scan detected reduced cerebral blood flow (CBF), especially around the temporal and parietal areas, and basal ganglia were not easily distinguished from surrounding tissue (presumably indicating extremely low tracer uptake in this area). The second scan (29 days after initial scan, and 49 days post-drug) detected nearly normal CBF, and tracer uptake was more homogenous than at first assessment. The authors explain the initial reduction in CBF as resulting from long-term MDMA effects on vasoconstriction. They note that reduced blood flow was seen approximately 25 days after acute MDMA administration in a laboratory setting (Chang et al. 2000), though participants in this study received no more than 2.5 mg/kg MDMA, as compared with a potential dose of 7 to 11 mg/kg. It may be difficult to generalize from this case because the patient had a history of head trauma and asthma, and because she ingested a high dose of ecstasy. As well, the authors did not specifically test for MDMA in urine on admission, raising the possibility that some or all of the tablets contained another drug in addition to or instead of MDMA. However, the findings at 20 days post-drug are in accordance with those reported by Chang and colleagues (Chang et al. 2000), and the second SPECT recording was made earlier than the later recording in 2 of 10 subjects made by Chang and colleagues that found increased CBF.