Loss of consciousness associated with this entity is similar to that occurring during panic attacks. However, prolonged hyperventilation may be subtle and represent an unimpressive, often unnoticed, manifestation of anxiety. The final common pathway, nonetheless, may be the same, featuring growing alkalosis, hypocarbia, and cerebral hypoperfusion. In addition, the associated, acute hypocalcemia often leads to dystonic contractions of the fingers, hands, wrist, and face, which may be confused with motor seizures. Because the manifestations of anxiety are less intense, hyperventilation syndrome may be more difficult to differentiate from epilepsy on clinical grounds alone. Nevertheless, a heightened level of suspicion usually allows the clinical diagnosis, which is helped by a history of flexion of both wrists.
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