Unrecognized paroxysmal ventricular standstill masquerading as epilepsy: a Stokes-Adams attack

Area of Science:

• Cardiology
• Neurology

Background:

• Distinguishing cardiac syncope from epilepsy is challenging in emergency settings.
• Convulsive episodes can be misdiagnosed as seizures.

Observation:

• A middle-aged man presented with recent-onset convulsions, initially puzzling diagnostically.
• The cause was identified as paroxysmal ventricular standstill with complete atrioventricular block.

Findings:

• Short, convulsive episodes with rapid consciousness return suggest syncope.
• Recurrent, unprovoked syncopal events may indicate cardiac origin.
• Electrocardiogram (ECG) monitoring is essential to capture transient arrhythmias.
• Clinicians must be aware of ECG machine settings to avoid misinterpreting atrial activity.

Implications:

• A thorough clinical history is paramount for differentiating convulsive syncope from epilepsy.
• Non-invasive cardiovascular assessments aid in diagnosing cardiac syncope.
• Timely diagnosis and intervention, such as pacemaker insertion, can lead to complete recovery.