Differentiating seizure and convulsive syncope: the importance of history taking

Distinguishing syncope with convulsions from a seizure disorder remains difficult. Convulsions occurring secondary to syncope typically result in an incorrect diagnosis of a seizure disorder. Available diagnostic testing often does not provide a conclusive answer; to ensure diagnostic accuracy, the careful and experienced clinician should obtain a patient history and physical examination. We present a case report, review the available literature, and analyze the accuracy of diagnostic testing. While no single diagnostic method works perfectly to determine whether loss of consciousness with associated convulsions results from seizure or syncope, accurate history taking is the first step and most sensitive diagnostic tool.