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Seizure or syncope: lessons over time
1Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02115, USA. vsheen@bidmc.harvard.edu
Summary
Recurrent syncope, not epilepsy, caused a seizure after a fall. Initial EEG and MRI suggested a seizure focus, but later resolved, indicating a head injury from syncope was the cause.
Area of Science:
- Neurology
- Neuroimaging
- Epileptology
Background:
- Recurrent syncope can be misdiagnosed as seizures.
- Distinguishing syncope from epilepsy is crucial for appropriate management.
Observation:
- A 25-year-old woman experienced syncope, followed by a generalized tonic-clonic seizure after a fall.
- Initial EEG and MRI showed abnormalities suggestive of a seizure focus.
- Follow-up imaging revealed resolution of abnormalities and evidence of traumatic brain injury.
Findings:
- The patient's symptoms were ultimately attributed to syncope complicated by head trauma, not epilepsy.
- Initial neuroimaging findings were transient and likely secondary to the head injury.
- Repeat EEG normalized, supporting the absence of an epileptic focus.
Implications:
- This case highlights the importance of considering syncope as a cause of seizure-like activity, especially after trauma.
- Accurate diagnosis is essential to avoid unnecessary anti-epileptic drug treatment.
- Understanding the etiology of loss of consciousness guides effective patient management and treatment strategies.
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