Syncope and epileptic seizure are frequent causes of transient loss of consciousness. In some cases, it may be somewhat difficult to distinguish one from the other despite the different pathophysiological mechanisms behind each entity.
However, in some cases, an epileptic seizure may eventually result in a syncope secondary to the development of significant bradycardia/asystole induced by the epileptic activity. This phenomenon, referred to as ictal asystole, is a potentially dangerous entity as it seems it might be a cause of sudden death in epileptic patients.
The aim of this case report describing two patients examined in our department and diagnosed to have the ictal asystole as the cause of recurrent episodes of unconsciousness involving a serious injury, is to present the "typical" symptomatology of the ictal asystole and to increase awareness of this entity among cardiologists so they start considering the ictal asystole in the differential diagnosis in routine clinical practice.