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Updated: Sep 2, 2025

Point of Care Transcranial Color-Coded Duplex Ultrasound of the Middle Cerebral Artery
Published on: August 9, 2024
[Reflex syncope-or more? : Ictal asystole!]
Thorleif Etgen1,2, Hans-Ruprecht Neuberger3
1Klinik für Neurologie, Klinikum Traunstein, Cuno-Niggl-Str. 3, 83278, Traunstein, Deutschland. thorleif.etgen@kliniken-sob.de.
Abstract:
A 59-year-old male patient was admitted for possible reflex syncope following loss of consciousness during urination. During the visit, a malaise with unconsciousness occurred. Holter ECG at that time showed increasing sinus bradycardia with transition to a junctional escape rhythm (30/min); in addition, there were several sinus pauses > 2.0 s (the longest almost 10 s). This malaise occurred again during routine EEG, when a focal epileptic seizure on the right fronto-temporal with sinus bradycardia after 15 s was documented. Thus, the diagnosis of ictal asystole was made, anticonvulsant therapy was started, and a cardiac pacemaker was implanted.
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