A 10-Year-Old Boy With Recurrent Syncope

Shatha M. Khatib, MD

Disclosures

August 15, 2017

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 10-year-old boy with a history of multiple fainting spells is brought to an outpatient pediatric clinic by his parents. These spells are sometimes complicated by generalized tonic-clonic "seizurelike" activity.

The patient first started experiencing these attacks 8 months ago. His mother has noticed that the fainting most often occurs either in the early morning, after the sounding of an alarm clock, or during some type of sports activity. The child states that the seizures occur without warning, and they are sometimes associated with urinary incontinence or vomiting. According to the patient's family, the child remains unconscious for about 1 minute, after which he awakens abruptly, with no evidence of confusion and full recall of all of the events preceding the attack.

The patient was born full-term, without any complications. He has no chronic medical conditions and is not on any medications. As a result of experiencing similar symptoms, his father was diagnosed with epilepsy and started on treatment at age 8 years; however, the father has been without treatment and has not had any attacks since age 14 years. The patient's paternal uncle was also diagnosed with epilepsy at age 10 years; he died during a seizure at age 19 years. The patient has an 8-year-old brother who is well, with no history of seizures or fainting spells.

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