EEG finding in a patient with vasovagal syncope

Syncope is characterized by a transient loss of consciousness due to cerebral hypoperfusion. The main differential diagnosis is made with epileptic seizures.The paper presents the case of a boy with three episodes of loss of consciousness, after an abrupt standing with complaints of lightheadedness, followed by falling, with short duration and with subsequent complaints of headache. During the EEG an episode of loss of consciousness was recorded, in sitting position, in which the boy reported lightheadedness, followed by tonic stretching, tightening of the arms, with single clonic contractions. After the episode, the child recovered rapidly, lacking postictal confusion. The EEG initially showed theta waves followed by high, irregular delta waves. Subsequently, flattening of the EEG trace was observed, after which high amplitude delta waves were recorded, followed by theta activity. Given the clinical course and ictal EEG findings in the absence of interictal epileptiform activity, the observed episode and the preceding identical episodes are discussed as syncopes.The differential diagnosis of epileptic seizures with other nonepileptic paroxysmal events, including syncope, remains a major diagnostic problem. The paper presents the characteristics of the clinical course and the typical EEG findings accompanying syncope, which facilitate the correct diagnosis.