[Reflex syncope-or more? : Ictal asystole!]

Area of Science:

• Cardiology
• Neurology
• Epileptology

Background:

• Reflex syncope and seizures can present with loss of consciousness.
• Urination can trigger various autonomic responses, including syncope.

Observation:

• A 59-year-old male experienced recurrent episodes of malaise and unconsciousness.
• Holter ECG revealed sinus bradycardia, junctional escape rhythm, and prolonged sinus pauses.
• An electroencephalogram (EEG) captured a focal epileptic seizure with concurrent sinus bradycardia.

Findings:

• The patient was diagnosed with ictal asystole, a rare event linking epileptic seizures with cardiac asystole.
• The cardiac pauses occurred during and after the epileptic seizure.

Implications:

• This case highlights the complex interplay between neurological and cardiac events.
• Prompt diagnosis and management, including anticonvulsant therapy and pacemaker implantation, are crucial for patients with ictal asystole.