TY - JOUR T1 - Unrecognized paroxysmal ventricular standstill masquerading as epilepsy: a Stokes-Adams attack. AU - You,Chi-Fang, AU - Chong,Chee-Fah, AU - Wang,Tzong-Luen, AU - Hung,Tzu-Yao, AU - Chen,Chien-Chih, PY - 2007/01/31/received PY - 2007/03/26/accepted PY - 2007/5/26/pubmed PY - 2007/9/7/medline PY - 2007/5/26/entrez SP - 179 EP - 81 JF - Epileptic disorders : international epilepsy journal with videotape JO - Epileptic Disord VL - 9 IS - 2 N2 - Recognition of cardiac syncope masquerading as epilepsy may be difficult in the Emergency Department. We report a middle-aged man with recent onset convulsions who posed a diagnostic puzzle before it was found that he had paroxysmal ventricular standstill with complete atrioventricular block: he made a complete recovery after temporary pacemaker insertion. The main lessons from this case were (1) a convulsive seizure of only seconds duration and with an abrupt return of consciousness suggests syncope not epilepsy, (2) repeated, convulsive syncopes without provocation suggest cardiac syncope, (3) a 12-lead ECG should be recorded as soon as possible after such a series of episodes and should not be discontinued until an event is captured, and (4) Emergency Department clinicians should be familiar with any automatic gain on their ECG machine, lest fast, atrial activity be mistaken for narrow complex tachycardia. In summary, a good clinical history is of prime importance in differentiating convulsive syncope from epilepsy, and a simple, non-invasive cardiovascular evaluation may help to diagnose the condition as cardiac syncope. SN - 1294-9361 UR - https://www.unboundmedicine.com/medline/citation/17525030/Unrecognized_paroxysmal_ventricular_standstill_masquerading_as_epilepsy:_a_Stokes_Adams_attack_ L2 - http://www.jle.com/medline.md?issn=1294-9361&vol=9&iss=2&page=179 DB - PRIME DP - Unbound Medicine ER -