Case report

A 45 year old left handed man presented with a four year history of paroxysmal events. He was referred by his neurologist for consideration of epilepsy surgery. Previous medical history was unremarkable. The first episode of loss of consciousness occurred while the patient was with friends. It was preceded by a brief period of severe chest pain with profuse sweating, which lasted less than a minute. A 12-lead electrocardiogram was normal. The second episode occurred two years ago and was also preceded by chest pain. During this episode, the patient felt weak, lay on the ground, and lost consciousness. Duration was uncertain, but on regaining consciousness he was sweating profusely. He interpreted these episodes as cardiac in origin as he has a strong family history of coronary artery disease. He was seen by a cardiologist who noted a normal cardiac examination, ambulatory electrocardiogram, exercise stress test, and transthoracic echocardiogram.

He had no further episodes until about nine months before referral. The first new episode started with a sensation of a sweaty smell followed by constricting chest pain for approximately 30 minutes, after which he lost consciousness. His wife described him as being in a profound sleep with heavy snoring. He recovered about 30 minutes later, initially shouting as if waking from a bad dream, but without subsequent confusion. There …