Unrecognized paroxysmal ventricular standstill masquerading as epilepsy: a Stokes-Adams attack.
Recognition of cardiac syncope masquerading as epilepsy may be difficult in the Emergency Department. We report a middle-aged man with recent onset convulsions who posed a diagnostic puzzle before it was found that he had paroxysmal ventricular standstill with complete atrioventricular block: he made a complete recovery after temporary pacemaker insertion. The main lessons from this case were (1) a convulsive seizure of only seconds duration and with an abrupt return of consciousness suggests syncope not epilepsy, (2) repeated, convulsive syncopes without provocation suggest cardiac syncope, (3) a 12-lead ECG should be recorded as soon as possible after such a series of episodes and should not be discontinued until an event is captured, and (4) Emergency Department clinicians should be familiar with any automatic gain on their ECG machine, lest fast, atrial activity be mistaken for narrow complex tachycardia. In summary, a good clinical history is of prime importance in differentiating convulsive syncope from epilepsy, and a simple, non-invasive cardiovascular evaluation may help to diagnose the condition as cardiac syncope.
You
Chi-Fang
CF
Emergency Department, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Chong
Chee-Fah
CF
Wang
Tzong-Luen
TL
Hung
Tzu-Yao
TY
Chen
Chien-Chih
CC
D000219:Adams-Stokes Syndrome / Q000175:diagnosis* / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D004562:Electrocardiography / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D004827:Epilepsy / Q000175:diagnosis*; D006323:Heart Arrest / Q000175:diagnosis* / Q000601:surgery; D006327:Heart Block / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial