Clinical Reasoning: A 25-year-old woman with recurrent episodes of collapse and loss of consciousness

Abstract

A 25-year-old woman presented to the neurology clinic describing 3 episodes of transient loss of consciousness over 9 months. The first 2 were unwitnessed, with no prodromal symptoms. The third event was a witnessed collapse while shopping. It was reported that both the patient's arms were stiff and by her sides with accompanied lateral tongue biting, a blue discoloration to her face, choking noises, and dilated pupils. The event lasted for less than 2 minutes, after which she was confused and drowsy. She remembered a premonitory feeling before the third collapse but found this difficult to describe.