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Vasovagal syncope treated as epilepsy for 16 years
Ali Akbar Asadi-Pooya1, Alireza Nikseresht, Ehsan Yaghoubi
1Department of Neurology,Medical school, Shiraz University of Medical Sciences, Shiraz, Iran. ; Department of Neurology, Thomas Jefferson University, Philadelphia, USA.
Iranian Journal of Medical Sciences
|February 1, 2013
Summary
Vasovagal syncope can mimic epilepsy, even causing tonic-clonic seizures and confusion. This case highlights the importance of considering vasovagal syncope in refractory epilepsy evaluations.
Area of Science:
- Neurology
- Cardiology
Background:
- Differentiating vasovagal syncope from epileptic seizures is clinically challenging due to overlapping symptoms.
- Vasovagal syncope can present with atypical features, including tonic-clonic convulsions and postictal confusion, mimicking epilepsy.
Observation:
- A patient with a 16-year history of medically-refractory epilepsy was re-evaluated.
- Subcutaneous injection of normal saline induced asystole, leading to hypoxia and a tonic-clonic convulsion.
Findings:
- The patient was definitively diagnosed with vasovagal syncope, not epilepsy.
- The induced event demonstrated how vasovagal syncope can manifest with seizure-like activity.
Implications:
- Consider vasovagal syncope in patients with refractory or atypical seizures.
- Simultaneous video-electroencephalogram/electrocardiogram monitoring is crucial for accurate diagnosis in ambiguous cases.
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