Medical education relies upon the through clinical examination and history taking in exact and proper diagnosis of the patient.1 The patient who has the symptoms which has the presentation of the multiple system sharing the same presentation need2 judicious examination and through evaluation. Similarly the article case study selected here is the syncope2 vs Siezure where both have the common feature such as the LOC– Loss of consciousness need the through evaluation for the same.3 Differentiating between syncope and seizures, a relatively easy task, is not quite so simple in the ED.4 Transient loss of consciousness can occur from seizure or syncope, and the emergency clinician must distinguish between the two general5 conditions, especially if it's the patient's first episode, and direct the appropriate initial evaluation and follow-up.6 Ten percent of patients diagnosed as having a seizure do not have a seizure disorder but rather a cardiovascular event that caused transient loss of consciousness.7 Basic ED labs and an ECG, even an out patient EEG, are not always sensitive enough to differentiate seizures8 from syncope. Long-term ECG monitoring, as well as tilt table testing, are some tools that can further reveal the origin of the transient loss of consciousness.9