Ictal asystole due to unsuspected cocaine abuse

This lesson describes a patient who had a cardiac arrest during an episode of status epilepticus provoked by a first fit. This is an exceptional sequence of events and should lead to investigation for an underlying cause. Unsuspected cocaine abuse is common and may provoke prolonged status epilepticus, particularly if there is a low seizure threshold. A toxic screen should be undertaken in all patients presenting with unexplained status epilepticus even if abuse of illicit substances is denied.