A 20-year-old man suffered a significant closed head injury after a diving accident. He is left with minor memory impairment but makes a full recovery. A few months later, he has a witnessed loss of consciousness with some arm and leg twitching. After the event, he is disoriented for 2 hours and then gradually returns to baseline. There was no incontinence or tongue biting, and his examination is normal. Which of the following is the most likely diagnosis?: (A) syncope, (B) generalized seizure, (C) focal seizure, (D) cardiac arrhythmia
Answer is B. This man had a generalized posttraumatic seizure. The prolonged confusion after the event suggests seizure rather than syncope. In the majority of cases, seizures do not develop until several months after the injury, 6-18 months being the most common interval. The more severe the injury, the greater the likelihood of seizures. For severe injuries, some authorities recommend prophylactic anticonvulsants for 1-2 years. There is no firm evidence for this, however.