Title PageBeyond the Surface: Recognizing VitaminB12 Deficiency in Thrombotic Thrombocytopenic Purpura-Like CasesAuthors:Inemesit Akpan MD – Piedmont Athens Regional Medical Center, 1270 Prince Avenue, Suite 102, Athens, GA. 30606. Inemesita11@gmail.com. Corresponding authorGhida Akhdar MD - Piedmont Athens Regional Medical Center, GeorgiaKaelan Dawson, DNP, AGACNP-BC – University Cancer & Blood Center, GeorgiaAmanda Hathaway MD - University Cancer & Blood Center, GeorgiaKeywords: Cobalamin deficiency, Vitamin B12, TTP, thrombotic microangiopathy, hemolytic anemia, thrombocytopenia

Brugada syndrome, though rare, poses a significant risk of sudden cardiac death, particularly in young adults, and remains underdiagnosed globally. We present the case of a 22-year-old male initially presenting with a presumed seizure episode, later found to exhibit findings suggestive of type 1 Brugada pattern on his admission electrocardiogram (EKG). Differential diagnosis between seizure and syncope was challenging, compounded by the difficulty in distinguishing convulsive syncope from seizure activity. While Brugada syndrome and epilepsy are not commonly associated, there is evidence suggesting a shared genetic basis, particularly in ion channel mutations. Our case underscores the importance of considering Brugada syndrome in patients presenting with seizure-like episodes and concerning EKG findings, prompting cardiology consultation and electrophysiological studies. The absence of a Brugada pattern post-ictally should not exclude diagnosis, especially in the context of appropriate clinical suspicion. Further research is warranted to elucidate the relationship between Brugada syndrome and epilepsy, and the potential implications for diagnosis and management.