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congestion. Most likely, however, TGA may refer to a single expression of several
pathophysiological phenomena82,83.

Fugue states may also be psychogenic, as a dissociative state symptom. Inconsistencies in
cognition and mental state are often elucidated if the patient is examined during an episode,
which may be prolonged, lasting days or even weeks.

Summary

In conclusion, there are a large number of neurological and cardiac conditions which result
in paroxysmal clinical events and although the causes are multiple and diverse, the clinical
manifestations may be similar. The attainment of an accurate and detailed history from the
patient and a witness is essential in differentiating these conditions. The application of
appropriate investigations frequently increases clinical yield and directs apposite therapy.
Nevertheless, misdiagnosis is common and may have profound physical, psychosocial and
socioeconomic consequences for the patient, and economic implications for the health and
welfare services

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