RT Journal Article
SR Electronic
T1 Recurrent episodes of falls and amnestic confusional states as diagnostic challenge in the elderly
JF BMJ Case Reports
JO BMJ Case Reports
FD BMJ Publishing Group Ltd
SP e228842
DO 10.1136/bcr-2018-228842
VO 12
IS 6
A1 Novitskaya, Yulia
A1 Götz-Trabert, Katrin
A1 Schulze-Bonhage, Andreas
YR 2019
UL http://casereports.bmj.com/content/12/6/e228842.abstract
AB New-onset paroxysmal events in patients over 60 years of age are often diagnostically challenging owing to atypical presentation. Recurrent falls and transient states of confusion are especially common in the elderly population, yet their causes often remain undiagnosed due to concomitant cognitive deficits and motor impairments. We present an elderly patient with newly occurring ‘blackouts’ without obvious triggers and transient states of confusion for which he was amnestic. All neurological exams including brain MRI scan and routine electroencephalography (EEG) were normal. Long-term ECG monitoring using an event recorder captured an asystole during a habitual episode, leading to the diagnosis of syncope and pacemaker implantation. A subsequent video EEG monitoring performed due to ongoing unexplained confusional states revealed both bradycardia and long-lasting confusional states to be caused by unrecognised temporal lobe seizures. Ictal video EEG monitoring may play a crucial role in establishing a diagnosis of atypical temporal lobe seizures in the elderly.