Ictal asystole: a diagnostic and management conundrum

We report two cases of adults presenting with transient loss of consciousness (TLoC) followed by a rapid recovery. Careful history taking revealed a stereotyped prodrome of déjà vu, raising the possibility of these events being focal seizures rather than syncope. The patients were commenced on antiepileptic drugs (AEDs) at the same time as having cardiac monitoring organised. This confirmed asystole during the seizure symptoms, resulting in TLoC.

A survey of the management of transient loss of consciousness in the emergency department

Background: Transient loss of consciousness (TLoC) is a common presentation to the emergency department (ED). We sought to evaluate current practice in the management of patients with TLoC presenting to a large, city centre ED, against national standards.
Methods: The ED admissions database was searched to identify all patients attending with TLoC during October 2012. The clinical record of the attendance was reviewed to determine if the initial assessment met national standards.

Care of the elderly symposium report

This symposium covered a wide range of conditions of interest to the geriatrician, the general physician and the general practitioner, including demographic shift, the epidemiology of ageing, diabetes in older people, investigation and management of falls, an update on stroke (including the role of neurovascular clinics, stroke thrombolysis and rehabilitation) and the management of coronary heart disease in the elderly.

All that shakes is not epilepsy

This review is based in part on Dr Hart’s lecture at the RCPE Symposium on Neurology in Edinburgh on 16 November 2011.Experience from the clinic suggests that many people equate the term ‘epilepsy’ with the occurrence of convulsions, with the corollary that attacks involving shaking are likely to be due to epilepsy.