Sometimes We Need the Electroencephalogram
A 72-year-old woman was admitted to the neurology service. She complained of recurrent episodes of a sudden loss of consciousness followed by “seizures” lasting 1 or 2 minutes with complete spontaneous recovery after a few seconds. The patient had suffered 5 or 6 episodes per day in the previous week. The history revealed 1 episode of intracranial hemorrhage without sequelae 6 months before. The ECG showed normal sinus rhythm with normal PR interval and QRS length. The patient was treated with phenytoin, but the “attack” recurred. An EEG was performed and during the scan, the patient suffered a new episode of loss of consciousness followed by generalized rigidity, spasmodic movements, and oculocephalic deviation. The episode lasted 15 seconds, followed by rapid and complete recovery. The EEG showed a prolonged (12 seconds) ventricular asystole (arrow) resulting from paroxysmal AV block (Figure 1), followed by a series of sharp waves initially on the left temporary region (Figure 2) with quick secondary generalization in form of slow waves of high voltage mingled with tips and sharp waves (*). Later on, depression of general voltage took place (#), followed by progressive recovery of the base rhythm (Figure 3). After a permanent pacemaker was implanted, the patient never suffered the “seizures” again.