Syncope resistant to anticonvulsant therapy.

It is recognised that physicians can face difficulty in identifying the aetiology of an episode of loss of consciousness. This lesson reports the case of a patient who was diagnosed with epilepsy in 2008 after presenting with ‘funny turns’ and had more than 100 further blackouts before a correct diagnosis of sinus node disease was made in 2010. Implantation of a permanent pacemaker has abolished these episodes and restored the patient's quality of life. Diagnostic and management strategies are discussed for patients presenting with loss of consciousness. Physicians are reminded of the difficulty in distinguishing cardiovascular syncope from epilepsy in such patients and the broader principle of questioning a diagnosis in those who do not appear to respond to treatment.