A 27-Year-Old Man Comes to the Office Due to Syncope

A 27-year-old man comes to the office due to syncope.  Two days ago, the patient was sitting at his computer at work and then suddenly awakened lying on the ground.  His coworkers saw him collapse to the floor, jerk a few times, and become still.  The patient was unconscious for 1-2 minutes.  He was not lethargic or confused after the episode and did not experience chest pain or shortness of breath.  The patient has had two similar episodes in the last year but did not seek medical attention.  He has become concerned following this third episode.  He has no medical history and takes no medications.  Temperature is 36.7 C (98.1 F) , blood pressure is 120/60 mm Hg, pulse is 72/min, and respirations are 16/min.  Pulse oximetry is 100% on room air.  The patient is awake, alert, and oriented, with normal speech.  He has a small occipital hematoma.  Oropharyngeal examination is normal.  The pupils are equal and reactive to light.  Heart and lung examinations are normal.  Strength is 5/5 in the upper and lower extremities, and gait is normal.  ECG is normal.  What is the best next step in management of this patient?

A) Ambulatory ECG monitoring
B) CT angiography of the chest
C) Electroencephalography
D) No additional workup
E) Noncontrast CT scan of the head

Correct Answer:

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