E-Pearl of the Week: Ictal Syncope
May 14, 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.
- 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.
- 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.