Moniaga Natalie C, Griswold Cheryl A
Naval Hospital Oak Harbor, NAS Whidbey Island, Oak Harbor, WA 98278, USA.
Aviat Space Environ Med. 2009 May;80(5):485-8. doi: 10.3357/asem.2397.2009.
Loss of consciousness is a symptom with a broad differential diagnosis. Distinguishing between syncope and seizure in a patient with a history of loss of consciousness can be equally difficult as their presentation can be very similar. We present the case of a naval electronic countermeasures officer who experienced a loss of consciousness while undergoing hypoxia training with the reduced oxygen breathing device (ROBD). During the episode the patient experienced tonic-clonic contractions with subsequent vertebral fractures, resulting in a prolonged grounding period. The patient's work-up focused on ruling out inherent cardiac and neurologic etiologies. After extensive examination and consultation with neurology, the patient was diagnosed with hypoxia-induced seizure, but was not felt to have an underlying seizure disorder. After reviewing his case, the Naval Aerospace Medical Institute felt that this incident represented a physiologic event and not a medical condition inherent to the aviator. It was, therefore, determined that this episode was not considered disqualifying and did not require a waiver for return to duties involving flight. Our discussion details the appropriate work-up for loss of consciousness, examines possible physiologic explanations for this event, and describes aeromedical considerations. The authors include the patient's physiology instructor, one, of the primary witnesses for the event, and the patient's flight surgeon, who was extensively involved in his care.
意识丧失是一种鉴别诊断范围广泛的症状。对于有过意识丧失病史的患者，区分晕厥和癫痫发作同样困难，因为它们的表现可能非常相似。我们报告一例海军电子对抗军官的病例，该军官在使用低氧呼吸装置（ROBD）进行低氧训练时发生了意识丧失。在发作期间，患者出现了强直阵挛性收缩，随后发生了脊椎骨折，导致长时间停飞。患者的检查重点是排除内在的心脏和神经病因。经过广泛检查并咨询神经科后，患者被诊断为低氧性癫痫发作，但被认为没有潜在的癫痫疾病。在审查他的病例后，海军航空医学研究所认为这一事件代表了一种生理事件，而非飞行员固有的疾病状况。因此，确定这一发作不被视为不合格，也不需要豁免即可恢复涉及飞行的职责。我们的讨论详细介绍了针对意识丧失的适当检查，探讨了该事件可能的生理学解释，并描述了航空医学方面的考虑因素。作者包括患者的生理学教员（该事件的主要证人之一）以及广泛参与其治疗的患者的飞行外科医生。
