Head Over Heart: An Atypical Presentation of Temporal Lobe Epilepsy

Ictal asystole is a long-documented medical condition that causes pauses during epileptic episodes. This condition has garnered attention due to resulting accidents. The mechanism of action and treatment guidelines are not well established. We present a case of a 39-year-old male truck driver who presented with dizziness, lightheadedness, confusion, and amnesia with a history of two motor vehicle accidents within one week. During his second hospitalization he underwent pacemaker placement due to presumed sinus node dysfunction. The patient returned with recurrent symptoms and was found to have epileptic focus of the left anterior temporal lobe on electroencephalogram and was thought to have ictal asystole. In this report, we focus on the importance of evaluating for neurogenic cause of cardiac arrythmias.