Ictal asystole is a rare epileptic phenomenon, though usually self-limiting, which has been associated with an increased risk of sudden death in epileptic patients. Although early recognition is desirable, the diagnosis can be delayed until prolonged video-EEG monitoring is completed. We report a case of ictal asystole in a 74-year-old patient with co-morbid cardiac conditions leading to a delay in diagnosis of approximately 10 years. Indeed, multiple cardiac investigations and EEGs failed to reveal that the recurrent syncope was seizure induced. A detailed description of the case with an emphasis on the prolonged diagnostic process, as well as the clinical and EEG findings, is provided. This case highlights the complexity of the diagnosis of some ictal asystole cases and the need to perform continuous video-EEG monitoring for confirmation. [Published with video sequence].
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