Summary

The differential diagnosis of causes of seizure is important since appropriate management depends on correct diagnosis. Making a misdiagnosis of epilepsy may lead to erroneous clinical management, and can be minimised with careful history taking and physical examination. Our educational case illustrates a patient with presumed epilepsy based on a witnessed generalised tonic–clonic seizure; he was ultimately diagnosed as upper gastrointestinal bleeding initially considered by careful attention of vital signs and rectal examination, and confirmed and treated by emergent endoscopy. Paying careful attention to the symptoms and signs in patients with seizure episodes is crucial to establishing a correct causative diagnosis for seizure.