Altered Mental Status 279274.A 58-year-old woman is brought in to the ED after a witnessed synco-
pal event. Upon arrival, the patient appears confused and agitated. Her vitals
include HR of 89 beats per minute, BP of 145/70 mm Hg, RR of 16 breaths
per minute, and oxygen saturation of 98% on room air. Within a few min-
utes, the patient is more alert and oriented. She denies any chest pain,
headache, abdominal pain, or weakness preceding the event and is currently
asymptomatic. She also states that she has not taken her antiepileptic med-
ications in 2 days. The patient’s examination is unremarkable including a
nonfocal neurological examination. Given this patient’s history and evolving
examination, what is the most likely etiology of this patient’s syncopal event?
a. Cerebrovascular accident
b. Transient ischemic attack
c. Seizure
d. Aortic dissection
e. Pulmonary embolus