EPILEPSY / SYNCOPE -
Snežana Mitrović, Biljana Radisavljević, Radica Krstić, Saša Ignjatijević, Goran Živković
Emergency Medical Service Niš, Srbija
INTRODUCTION: The distinction between syncope and epilepsy is sometimes a diagnostic problem. In this paper, we briefly summarize the symptoms of syncope and present the case of a patient who was diagnosed and treated for epilepsy for 5 years, and who later had syncope caused by a change in heart rate due to episodes of atrioventricular block. The short duration of these episodes made diagnosis difficult. Episodic loss of consciousness is a common clinical manifestation, but the causes and pathophysiological mechanisms that lead to loss of consciousness are different, with different outcome and risk of death. Syncope and epilepsy can be triggered so that epileptic seizures can trigger syncope and syncope can trigger an epileptic seizure. Approximately 90% of all epileptic seizures are accompanied by tachycardia, and ictal asystole and bradycardia occur in 0.3–0.5% of seizures. Ictal bradycardia, asystole, or atrioventricular block are likely to end spontaneously and occur due to vagal activation induced by the attack. Cessation of cortical activity due to syncopal cerebral hypoperfusion will end the attack. Therapy requires antiepileptic drugs and pacemaker. The second form refers to cardiovascular syncope with abnormal movements due to cerebral hypoxia.
AIM: by presenting the case, we wanted to point out the need for careful evaluation of a patient with loss of consciousness due to the possibility that the cause lies in cardiac dysrrhythmias.
METHODS AND MATERIAL: Medical report of the Institute for Emergency Medical Service Nis, Specialist reports and Discharge lists of the Clinic for Neurology and Clinic for Cardiology.
DISCUSSION: After the initial examination, patient should be assessed whether he/she is at high or low risk of cardiovascular events and sudden cardiac death. High-
CONCLUSION: Patients may have two or more etiopathogenetic factors of transient loss of consciousness at the same time. Therefore, a multidisciplinary approach is needed, including cardiac and neurological examinations. In prehospital conditions where diagnostic possibilities are limited, the cause of the loss of consciousness must be recognized as soon as possible. It will lead to an unfavorable outcome, especially in patients with cardiovascular syncope in the subgroup of patients with malignant arrhythmias and high-
Key words: syncope, epilepsy, transient loss of consciousness, AV block, multidisciplinary approach.
Zavod za hitnu medicinsku pomoć Niš
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