Patient presents s/p syncopal episode. EKG appears Brugada-ish. Does a previous normal cardiac echo exclude Brugada syndrome?

No.

Brugada syndrome is diagnosed when there are characteristic EKG changes associated with one of the following:

• documented ventricular fibrillation
  
• polymorphic ventricular tachycardia
  
• family history of sudden cardiac death at age less than 45 years old
• inducibility of VT with programed electrical stimulation

Source

Kass, R. and Clancy, C. Basis and Treatment of Cardiac Arrhythmias. 2006.