Kouakam C, Daems-Monpeurt C, Le Franc P, Derambure P, Josien E, Kacet S
Service de cardiologie A, CHU Lille, hôpital cardiologique.
Arch Mal Coeur Vaiss. 1999 Feb;92(2):265-8.
The authors report the case of a 37 years old woman with no previous medical history, admitted to hospital for investigation of unexplained syncope, sometimes associated with generalised fits. After standard non-invasive cardiovascular investigations, no diagnosis could be made. The tilt test induced a minor syncopal episode without reproducing the clinical symptoms. In view of the discordance between the induced and spontaneous symptoms, a neurological opinion was requested. During the recording of an electroencephalogram, syncopal atrioventricular block was observed, preceded by auditory hallucinations, reproducing exactly the clinical symptoms. Analysis of the sequence of events showed the conduction defect to arise after the onset of the epileptic fit, indicating a diagnosis of syncopal complete atrioventricular block complicating cryptogenic temporal epilepsy, and requiring specific treatment. This case illustrates the importance of close collaboration between cardiologists and neurologists in the management of cases of unexplained syncope.
作者报告了一例37岁女性病例,该女性既往无病史,因不明原因晕厥(有时伴有全身性抽搐)入院接受检查。经过标准的非侵入性心血管检查后,仍无法做出诊断。倾斜试验诱发了一次轻微的晕厥发作,但未再现临床症状。鉴于诱发症状与自发症状不一致,遂征求神经科意见。在脑电图记录过程中,观察到晕厥性房室传导阻滞,发作前有幻听,与临床症状完全相符。对事件序列的分析表明,传导缺陷在癫痫发作开始后出现,提示诊断为晕厥性完全性房室传导阻滞并发隐源性颞叶癫痫,需要进行特殊治疗。该病例说明了心脏病专家和神经科专家在不明原因晕厥病例管理中密切合作的重要性。