Syncope or Seizure?

Syncope is a common complaint in the emergency departments, accounting for 1-2% of visits, and can approach admission rates of a staggering 85%. The causes and conditions can be numerous, ranging from benign to life threatening. A good background history can go a long way in determining the etiology of the patient’s syncope. We describe a case of an elderly male who presented with a reported chief complaint of seizures, another syncope-mimic seen in the emergency department. He had a history of CAD, HTN, AAA, and osteoarthritis but no prior history of cardiac arrhythmia, MI, or structural heart disease. The wife noticed collapse followed by seizure-like activity after opening the refrigerator. The initial EKG was non-specific. During his course in the ED there was a witnessed syncopal episode with upper extremity shaking and return to mental baseline within a minute of the event. A repeat EKG showed complete heart block. Seizures are a common presentation and chief complaint in the emergency department. It is easy to get tunnel vision in the clinical pathway and treatment plan. Other less common presentations of loss of consciousness with rhythmic shaking include convulsive syncope and should be considered. It is important to cast a wide net in the initial workup and always consider convulsive syncope, especially in an elderly patient with risk factors