E-Pearl of the Week: Ictal Syncope

May 14, 2013


Interested in submitting an e–Pearl? Click here!

Brought to you by the Resident and Fellow Section of Neurology®.

May 24, 2013

Ictal Syncope

Syncope is an abrupt loss of consciousness, often followed by rapid and spontaneous recovery. The differential diagnosis is broad and includes several neurologic and neurally–mediated conditions. Uncommonly, syncope can be induced seizure. Loss of consciousness in ictal syncope is thought secondary to cerebral hypoperfusion after peri–ictal asystole, peri–ictal bradycardia, or less commonly peri–ictal atrioventricular conduction block. [1] A retrospective review of 6,825 patients undergoing long–term video–electroencephalographic monitoring at a tertiary care center found ictal asystole and atonia present in 0.27% of patients with epilepsy. [2] These patients had no cardiac disease and had normal electrocardiograms between events. All patients had focal epilepsy, most with intractable temporal lobe epilepsy.


  1. Surges R, Scott CA, Walker MC. Peri–ictal atrioventricular conduction block in a patient with a lesion in the left insula: case report and review of the literature. Epilepsy and Behavior 2009; 16: 347–349.
  2. Schuele SU, Bermeo AC, Alexopoulos AV, et al. Video–electrographic and clinical features in patients with ictal asystole. Neurology 2007; 69: 434–441.

Submitted by Adam Numis MD, Resident Physician, University of California, San Francisco.

Disclosure: Dr. Numis is a member of the Resident and Fellow Section of Neurology.

For more clinical pearls and other articles of interest to neurology trainees, visit www.neurology.org and click on the link to the Resident and Fellow Pages. Click here to visit the E–Pearl of the Week Archive.

Click here to listen to this week's Neurology® Podcast.