title: Vasovagal syncope misdiagnosed as epilepsy for 17 years: prime importance of clinical history.
abstract: Distinguishing epilepsy from syncope often can be challenging. We report a case of a 20-year-old patient with presumed refractory epilepsy since the age of 3 years. Although the clinical suspicion of syncope was raised at the age of 9 years, key historic features were not identified, cardiac work-up was not pursued and despite lack of electrographic evidence of epilepsy, he received anticonvulsant treatment. During his presurgical evaluation for "refractory epilepsy", one typical event was captured that was associated with asystole and normal electroencephalogram. The diagnosis of vasodepressor syncope was made and anticonvulsant medication was discontinued. With this case report, we would like to emphasize the importance of a meticulous history and the need to perform continuous video electroencephalographic with simultaneous electrocardiographic recordings in the evaluation of paroxysmal events with atypical presentation. [Published with video sequences].
authors.affiliation: Neurology Department, Henry Ford Hospital, MI 48202-2689, USA. spanaki@neuro.hfh.edu
authors.forename: Marianna V
authors.initials: MV
authors.lastname: Spanaki
authors.forename: Patricia
authors.initials: P
authors.lastname: Garcia
authors.forename: Claudio D
authors.initials: CD
authors.lastname: Schuger
authors.forename: Brien J
authors.initials: BJ
authors.lastname: Smith
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004827:Epilepsy / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008487:Medical History Taking; D008790:Metoprolol / Q000627:therapeutic use; D019462:Syncope, Vasovagal / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D000319:Adrenergic beta-Antagonists; D008790:Metoprolol