Abstracts

Rationale: Syncope is secondary to cerebral hypoperfusion and at times, manifests as "convulsions" that are frequently misdiagnosed as epilepsy. We report a patient with convulsive syncope following asystole while on video EEG monitoring. Methods: Continuous EKG and video EEG monitoring were performed. Results: 23 year old man presented with recurrent "blackout" spells and was admitted to the epilepsy monitoring unit for definitive diagnosis. Following admission to the unit, the patient had an event that was preceded by venipuncture. The event began with sudden onset bradycardia that progressed to asystole and was followed by diffuse EEG slowing that progressed to marked generalized suppression (Figure 2). Total asystole lasted for 34 seconds and total EEG suppression lasted for 29 seconds (Figure 1). Clinically, during the event the patient slumped down in bed and was unresponsive. Following the return of activity on EEG, he had bilateral posturing of his arms and eye twitching. Conclusions: s: Our patient had an event that is typical of convulsive syncope which is non-epileptic in nature. Some studies have reported that approximately 1/3rd of patients initially thought to have epileptic seizures were later found to have convulsive syncope due to cardiovascular cause. This case reiterates that not all convulsive episodes are epileptic in nature and patients would benefit from earlier cardiac monitoring. This case happens to capture the syncopal event on both Video EEG and EKG monitoring providing a definitive diagnosis of his spell. Our patient was discharged after a complete cardiac work up with an ILR for further monitoring prior to decision for a permanent pacemaker placement. Funding: None