80yo man for L TKR.
- Episode of LOC several years ago
- Isolated event. Nil seizure-like features.
- Witnessed by family members
- Extensive review by neurologist – EEG showed prominent epileptiform features in the temporal lobe which were reproducible on repeat testing.
- EEG abnormalities resolved with commencement of Levetiracetam.
- Bifascicular block on ECG, HR 59, no cardiologist review
Should we be concerned about a cardiac cause for his LOC?
- Reassuring features:
- One distant episode.
- Now treated for epilepsy. No further episodes.
- EEG showed a gross abnormality and repeat EEG after treatment was normal.
- Concerning features:
- Episode doesn’t really sound like a seizure. Sounds more cardiac in origin.
- Unlikely that a cardiologist be interested in one episode of LOC
- Holter = low risk study however likely wasted resource and burdensome to patient
- Proceed with surgery without further investigations.