Is it a seizure or is it syncope: going over the basics again

Is it a seizure or is it syncope: going over the basics again

Nitin K. Sethi, MD

Assistant Professor of Neurology

New York-Presbyterian Hospital

Weill Cornell Medical Center

New York, NY 10065


I have written about this before but thought this would be a good time to go over the basics again. So let us begin with an example. Our main actor (lets call him John) is working in his office. The clock strikes 12 and he decides to step outside to smoke.  It has been a tough day at work for John.  Went out with a couple of friends last night and had one too many Jack Daniels on the rocks (with a slice of lime!!!).  This liberal indulgence in the bubby resulted in John waking up dehydrated and with the worst hangover of his life. That combined with a cold he is still nursing and you can imagine John is a very unhappy camper.

So John  steps out to smoke. Lights up and takes a deep puff. Ahhhhhhhhhhhhhh. And then it happens. He feels light headed, dizzy, his vision starts to grey and before he knows it he is on the floor.  His friend who sees him fall, rushes to help him. By the time he reaches John, John is already coming around. He attempts to get up on his feet and asks his friend what happened. He is alert and oriented and apart from a bruised ego, he feels well.


Now lets go to case scenario number 2. John is again our main actor. In this case though John is having a good day. He slept well the night before and steps out to have a smoke. He lights up. Ahhhhhhhhhhh. Life sure feels good. And then it happens. He stiffens up. A cry is heard (we call this the epileptic cry) and then he takes a hard fall to the ground.  After falling to the ground, he is noted to “shake” by his friend who has since rushed to his side ( I saw him shaking–both arms and legs, it was horrible. He was foaming at the mouth and I thought he was going to die is how his friend describes the event to the EMS later on!!!). After a minute, John stops shaking but he does not come around immediately. He remains confused and disoriented till the arrival of the EMS 15 minutes later. John later tells the doctor in the ER that he has bitten his tongue and lost control of his bladder (wet his pants) during the episode.

So after presenting these two case scenarios, my question to you is in which scenario did John have a syncope (fainting episode) and which was a seizure?

In the next post we shall pick up John’s story from the ER. Hopefully we can make him feel better.


6 thoughts on “Is it a seizure or is it syncope: going over the basics again

  1. This is probably a trick question. I bet you’ll say both were. 🙂
    But everything I know says the first example is fainting, the second is a seizure.

    1. You are very right Paul. Thank you for writing in. Hope you are well.

      Personal Regards,
      Nitin Sethi, MD

  2. i came upon this after going through seizure like activity with my 15 yr old daughter. She has episodes where her legs buckle, she passes out, limbs stiffen and jerk around. She also foams at the mouth and sometimes is very confused afterward and kinda stares around. …my question? is it NOT a real seizure due to the fact that she does not bite her tongue or loose control of her bladder? The dr. is saying maybe neurally mediated syncope. but he hasnt heard of the foaming at the mouth with this diagnosis? Do u have any answers or direction for me? I am trying to find anything i can. thank you
    meggie’s mom,(a super sweet 15 yr old girl who needs her life back)

  3. Dr. Sethi,

    I am writing to you about my partner and hoping you can help.
    He has had two episodes in the past 4 months. The first was a syncope, fainting spell without seizure. He did complain of light headedness and dizziness before he went down, sliding down the tiled wall of the subway station. He regained consciousness quickly and although he felt weak continued on and within a 1/2 hour felt perfectly fine. The second incident happened last week. He complained of light headedness again, we sat down and then he had a seizure. Eyes rolled back, with a convulsive shake. There was no tongue biting or loss of bladder control. He regained consciousness quickly and said his breathing was labored. He also said his vision became dark before hand. I took his pulse a while after the incident and it was quite low, around 50. Hours later it was around 70. My partner is a 56 year old man. He is a hard core cyclist (40-60 miles a ride), a vegetarian, 5’10 and weights between 169-174. He doesn’t suffer from high blood pressure but was told his heart skips beat. However, he did so well on his annual stress test, the doctor told him not to worry. My partner is not worried about these attacks and loathes the idea of going into the medical system to take test after test. He has agreed to see one doctor if I manage the administrative aspects. I understand a history is very important here. Do we see a cardiologist? A neurologist? Do you have any suggestions? I have to say I read about a syndrome called Adams Stokes and it did scare me quite a bit. I know this could be many things but I am anxious for him to see someone soon and it has to be a good diagnostician. Your thoughts would be much appreciated as well as any referrals (Including yourself). We are in New YOrk city.

    Thank you,

  4. My name is frank, I remain somewhere in the middle of these two people, had a syncope/seizure, standing at the sink 10 am, woke up maybe 5 or 10 minutes later on the floor face down, my tee shirt soaked, top of my workout shorts wet, (not urine) went to pcp, went for cat scan at 3pm, filled out all the paper work perfectly legible, sat down, slumped over on person next to me, woke up in ambulance, to er, hosp for 3 days, many tests, nothing. Saw neurologist, eeg, normal, saw eye doctor all fine. Had stess test, epstudy, angiogram, history of heart problems, holter monitor,tilt table, all fine. 5 weeks later out to dinner with friends, had a large bowl of soup, woke up in hospital, spent night, was put on dilantin 300mg day, had vineo eeg week later, normal no propensity for problem showed. By the way iam 70 years old, in shape, very active. also diagnosed in april with hiatal hernia. Dilantin is killing me! Help!

  5. I too have been experiencing syncope episodes on a fairly regular basis (every 2 1/2 weeks since Aug. 2012). I can feel them coming on and I become extremely confused and weak, resulting in the need to lie down until it passes. This takes anywhere from 1 to 5 minutes. I have last consciousness briefly on 2 occasions. I have undergone many tests( EEG , ECG regular and sleep deprived, results pending – plus carotid Doppler, CAT scan, blood work, full physical, heart monitors- all normal. I am grateful that my doctor has been so thorough, but concerned that no ” diagnosis” has occurred. I would greatly appreciate your thoughts on this. I am an otherwise healthy 55 yr. old female. I had a complete hysterectomy 5 years ago and I am not on any medication.

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