Linzer M, McFarland T A, Belkin M, Caplan L
Syncope Evaluation Center, Tufts University School of Medicine, New England Medical Center, Boston, MA 02111.
Stroke. 1992 Jul;23(7):1017-20. doi: 10.1161/01.str.23.7.1017.
Cough syncope typically occurs in patients with known chronic lung disease. The mechanism usually involves a combination of decreased venous return, increased cerebrospinal fluid pressure, and secondary hypocapnia, all resulting in cerebral arterial vasoconstriction. Cough syncope has not in the past been associated with occlusive cerebrovascular disease.
We describe a 50-year-old man with a 6-month history of episodes of loss of consciousness during paroxysms of coughing. Physical examination showed asymmetrical upper extremity blood pressures and carotid and subclavian artery bruits. Pulmonary function studies were normal. Ultrasound and angiography showed total occlusion of the left common carotid artery, right internal carotid artery, and right vertebral artery; tight stenosis of the right subclavian artery; and a hypoplastic left vertebral artery. The patient had a left subclavian-to-left common carotid artery bypass and has had no syncope since that time.
To our knowledge, this is the first reported case of cough syncope and severe cerebrovascular disease in which surgery led to amelioration of symptoms. Cerebrovascular occlusive disease may contribute to cough syncope.
咳嗽性晕厥通常发生于已知患有慢性肺部疾病的患者。其机制通常涉及静脉回流减少、脑脊液压力升高和继发性低碳酸血症共同作用，所有这些都会导致脑动脉血管收缩。过去，咳嗽性晕厥与闭塞性脑血管疾病并无关联。
我们报告一名50岁男性，有6个月在咳嗽发作时出现意识丧失发作的病史。体格检查显示上肢血压不对称，颈动脉和锁骨下动脉有杂音。肺功能检查正常。超声和血管造影显示左颈总动脉、右颈内动脉和右椎动脉完全闭塞；右锁骨下动脉严重狭窄；左椎动脉发育不全。该患者接受了左锁骨下动脉至左颈总动脉搭桥手术，自那以后未再发生晕厥。
据我们所知，这是首例报道的咳嗽性晕厥合并严重脑血管疾病且手术使症状改善的病例。脑血管闭塞性疾病可能导致咳嗽性晕厥。
