Ictal asystole with isolated syncope: A case report and literature review

Ictal syncope is a rare phenomenon that occurs in association with 0.002–0.4% of seizures. In the absence of other symptoms, seizures presenting with syncope may be challenging to diagnose. We report a case of a previously healthy male who developed recurrent episodes of syncope with postictal confusion and was later diagnosed with temporal seizures. The patient was successfully treated with anti-seizure drugs and placement of a cardiac pacemaker. In a systematic review of literature, we summarize the clinical characteristics of patients with ictal asystole and isolated syncope. Seizures should be considered in patients with syncope of uncertain etiology.
Highlights • Focal seizures leading to bradycardia-asystole can be accompanied by sudden atonia with loss of consciousness • Ictal syncope as the only symptom of seizure represents an exceptionally rare phenomena that may mimic other paroxysmal neurological events • Patients with recurrent syncopal events of uncertain etiology should have seizures considered in the differential diagnosis