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Related Experiment Videos

Syncope--brain or heart? A case report.

H Nilsson1, M Freitag, B Hindfelt

  • 1Department of Neurology, Malmó General Hospital, University of Lund, Sweden.

Pacing and Clinical Electrophysiology : PACE
|June 1, 1992
PubMed
Summary

Recurrent unconsciousness was initially misattributed to heart asystole, but later diagnosed as epilepsy. This case highlights the complex brain-heart connection in diagnosing syncope.

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Area of Science:

  • Neurology
  • Cardiology
  • Epileptology

Background:

  • Recurrent syncope presents a diagnostic challenge, often requiring extensive investigation.
  • The differential diagnosis for syncope includes cardiac and neurological etiologies.

Observation:

  • A 44-year-old male presented with recurrent, unexplained episodes of unconsciousness.
  • Initial investigations, including electroencephalogram (EEG) and computed tomography (CT), were inconclusive.
  • Prolonged Holter monitoring identified a single episode of asystole lasting 7.6 seconds.

Findings:

  • Pacemaker insertion failed to resolve the patient's episodic syncope.
  • Subsequent long-term EEG monitoring revealed epileptiform activity with independent foci in both temporal lobes.
  • Antiepileptic drug treatment successfully eliminated the patient's symptoms.

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Implications:

  • This case underscores the critical, often overlooked, relationship between cardiac and neurological function in the presentation of syncope.
  • Epileptiform activity should be considered in the differential diagnosis of recurrent syncope, even after cardiac causes have been investigated.
  • Comprehensive diagnostic approaches integrating cardiology and neurology are essential for managing complex cases of unexplained syncope.