One Brugada Syndrome Patient with Ventricular Fibrillation Misdiagnosed as Secondary Epilepsy

The patient was a 47-year-old male who had 3 syncope and convulsion episodes over a 1-month period. The patient experienced right temporal bone fracture 3 years previous to this admission. At the first admission period, his interictal electroencephalogram (EEG) was normal, but he was misdiagnosed as secondary epilepsy because of the history of temporal bone fracture. In second admission, his electrocardiogram (ECG) revealed atrial fibrillation, partial right bundle branch block (RBBB), and J-point and ST-segment elevation in right precordial leads. The ST-segment was downward elevation on lead v1. But the ST-segment showed typical coved-pattern ECG of Brugada syndrome on lead v2. While the patient was in syncope, the ECG monitor revealed ventricular fibrillation. The ST-segment fell to the basic level on lead v1 and the coved-pattern ECG disappeared on lead v2 after administration of intravenous isoprenaline (0.25 μg/kg·min) for 2 hours. The patient was free of syncope and convulsion after implanted implantable cardioverter defibrillator (ICD) and administration of amiodarone to prevent atrial fibrillation.

At first admission, the patient was diagnosed secondary epilepsy because of the history of temporal bone fracture, syncope and convulsion, although there was the normal interictal electroencephalogram. It was regretted that we didn't follow him up further.