Transient loss of consciousness with muscle jerks during a flight: syncope or epilepsy: Difference between revisions

==Case Report==

A 35 year old otherwise healthy engineer was referred to the syncope unit for analysis of an episode of loss of consciousness, which occurred during a flight on return from a week-long holiday in Turkey. Prior to boarding the airplane at midnight, the patient felt tired and was continuously yawning without any other specific complaints. Once seated in the aircraft, he fell asleep almost immediately. After approximately 30 minutes of sleep he retrieved an item from the overhead compartment without problems, after which he quickly fell asleep again. About one hour later, he woke up feeling weak and extremely thirsty, and decided to have a softdrink. The patients’ partner, a cardiology resident, was subsequently woken up by the sound of the softdrink can falling on the floor and she noticed that the patient was unconscious with muscle spasms and an upward turning of the eyes. Shortly after this, the muscle spasms were replaced by jerking of (most noticeably) the arm muscles, after which he became completely flaccid. His pulse was very slow and weak and he was breathing superficially. Before he could be transferred from his chair to the aisle, he regained consciousness. The duration of the period of unconsciousness was short (< 3 min). On regaining consciousness he was well orientated but complained of tiredness, weakness and slowness in thinking and speech. There was no sign of urine incontinence or tongue biting. When he tried to stand up and walk a few steps he collapsed again without losing consciousness. After a few minutes he was able to stand up and walk by himself. On examination, his pulse was approximately 40-45 beats/min (regular) with a blood pressure of 100/60. He complained of muscle pain in his arms and shoulders, blurred vision, tiredness, and cold sweats. These symptoms gradually disappeared during the following 2 hours, after drinking 3 to 4 glasses of water with sugar. On arrival at the airport, he was checked by ambulance personnel and found to have a normal heart rate, blood pressure and blood glucose level.  Physical and neurological examinations and EKG analysis performed at the Emergency Department of the Academic Medical Centre showed no abnormalities, after which he was referred to our syncope unit.