Neurally-mediated syncope is the most common cause of transient loss of consciousness. In this report, we describe an index case of a 43-year-old man with multiple episodes of neurally-mediated syncope. He underwent tilt-table testing, resulting in asystole for 15 seconds with generalized convulsions. After permanent pacemaker implantation, the patient had another syncopal episode requiring adjustment of pacemaker settings. Current concepts of the pathophysiology as well as the diagnosis and management of this condition are discussed.