Silent Storm: Ventricular Standstill Masquerading as Seizure in Adams-Stokes Syndrome

Abstract

Paroxysmal ventricular standstill is one of the rarest but life-threatening cause of Adams-Stokes (A-S) syndrome. We present the case of an elderly female who experienced recurrent episodes of convulsions, described as tonic movements of all limbs followed by brief loss of consciousness, due to paroxysmal ventricular standstill. The diagnosis was confirmed when an episode of convulsions coincided with an ECG strip showing ventricular standstill, and the convulsions stopped once the arrhythmia resolved, as observed on the cardiac monitor. The diagnosis was further supported by the absence of additional convulsive episodes after the insertion of a temporary transvenous pacemaker, which corrected the arrhythmia. Adams-Stokes syndrome refers to a lack of brain perfusion caused by inadequate or inefficient cardiac contractility due to a cardiac arrhythmia. This can result in abnormal brain activity, leading to convulsions or syncope.