[52-year old patient with recurrent syncope and temporary right precordial EKG-changes with fever]

This case report highlights the importance of considering the differential diagnosis of a primary electrical cardiac disease in a patient with unexplained syncope. In the absence of positive findings in his cardiac and neurological work-up, the presented patient had been diagnosed with "cryptogenic" epilepsy. During a febrile episode, however, his 12-lead ECG showed ST-segment elevations in leads V(1) and V(2), typical for the Brugada-Syndrome. Hence, his antiepileptic medication was discontinued and the patient received an implantable defibrillator. Pathophysiology, diagnosis, risk stratification, as well as the treatment options for this disease of the cardiac sodium channel are reviewed.