Cardiogenic syncope in patient incorrectly diagnosed with GTCS

This video-EEG-ECG demonstrates cardiogenic syncope in a patient referred with an incorrect diagnosis of GTCS. During routine video-EEG, this patient developed sinus bradycardia and then ventricular standstill for 9 seconds, with one escape ectopic beat as documented with ECG (bottom trace). Clinically, at the oblique arrow the technologist asked him if he felt okay and he said no. At the vertical arrow his eyes rolled slowly upwards to the extreme. At the open arrow, he became flaccid and unresponsive and his head dropped backwards. Some recovery started at the double-headed arrows when he took two snorting breaths. At the black arrowhead, he resumed his position as before the syncope. Afterwards he was confused, he could not answer questions and, when asked again what happened to him, he was distressed and cried. He did not come back to normal until after more than 4 minutes from the start of the syncope. (Used with permission: Panayiotopoulos CP. A clinical guide to epileptic syndromes and their treatment. Revised 2nd edition. London: Springer, 2010.)