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Brought to you by the Resident and Fellow Section of Neurology®.
May 24, 2013
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.  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.  These patients had no cardiac disease and had normal electrocardiograms between events. All patients had focal epilepsy, most with intractable temporal lobe epilepsy.
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.
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