Recurrent Syncope in a 30-Year-Old Whose Uncle Died Suddenly

Thomas J. Hemingway, MD; Rick G. Kulkarni, MD, FACEP

Disclosures

November 02, 2021

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

Background

A 30-year-old man of Japanese descent presents to the emergency department (ED) after experiencing a syncopal event at home. His wife, who has accompanied him to the ED, witnessed the event. She states that they had been talking in the kitchen when her husband complained of feeling dizzy. He then became nauseous and slumped over onto the table; before she could get up and help him, he fell out of his chair and hit his head on the floor. After some time lying on the floor, he regained consciousness.

The wife did not notice any seizurelike activity (including no jerky body movements, tongue biting, or incontinence) while her husband was unconscious. When he regained consciousness, he was immediately fully awake, alert, and conversant; no period of confusion or garbled speech was noted.

The patient reports that he has had many similar episodes in the past several years, but he has never sought medical evaluation for them. At the time of presentation, the patient has no specific complaints other than a bruise on his forehead and mild embarrassment. The patient's family history is significant for an uncle who died in his 30s without apparent cause.

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