Exercise-Induced Syncope with Neurological Symptoms in Young Female Runner

Case at a Glance

An 18-year-old female competitive runner presented with loss of consciousness during a 10-mile run in hot weather, accompanied by tongue laceration, head trauma, and post-ictal confusion.

Patient's Story

The patient was completing a routine 10-mile training run on a particularly hot day. She reported feeling well initially, but during the final mile began experiencing progressive body stiffening and confusion. She recalled involuntary muscle twitching before losing consciousness. Upon regaining consciousness, she found herself on the ground with a bleeding tongue, head laceration, and severe neck pain. She experienced prolonged disorientation and was unable to immediately recognize her location. After resting, she was able to walk home independently.

Initial Assessment

The patient presented with a history of sudden loss of consciousness during intense physical activity in hot conditions. Physical examination revealed tongue laceration consistent with seizure activity, minor head trauma, and neck pain. Vital signs showed mild dehydration. The patient appeared alert but reported lingering confusion and fatigue.

The Diagnostic Journey

Initial differential diagnosis included exercise-induced syncope secondary to dehydration, heat exhaustion, electrolyte imbalance (particularly hyponatremia), or seizure disorder. The presence of tongue biting, muscle twitching, and post-ictal confusion raised concern for seizure activity. Laboratory studies were ordered including complete metabolic panel, particularly focusing on sodium levels, and EEG was considered to rule out underlying seizure disorder.

Final Diagnosis

Exercise-induced syncope with possible seizure activity, likely secondary to heat exhaustion and electrolyte imbalance. The combination of prolonged exercise in hot conditions, dehydration, and possible hyponatremia contributed to the syncopal episode.

Treatment Plan

Immediate management focused on rehydration with oral electrolyte solutions and rest. The patient was advised to avoid strenuous exercise until fully recovered and to implement heat illness prevention strategies including adequate hydration, electrolyte replacement, and avoiding exercise during peak heat hours. Neurology consultation was recommended to rule out underlying seizure disorder given the clinical presentation.

Outcome and Follow-up

The patient was advised to seek immediate medical evaluation given the severity of symptoms and potential for serious underlying conditions. Follow-up was scheduled within 48 hours to reassess neurological status and review laboratory results. Education was provided regarding warning signs of heat-related illness and the importance of proper hydration during endurance activities.