Department of Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
Postgrad Med. 2010 Nov;122(6):137-44. doi: 10.3810/pgm.2010.11.2231.
Syncope is a common complaint that is frequently evaluated without identifying a precipitating cause. Gelastic (laughter-induced) syncope is an uncommon and poorly understood condition. We describe 3 patients who experienced loss of consciousness during vigorous laughter. Each patient had an extensive medical evaluation, including a comprehensive history and physical examination, 12-lead electrocardiography, chest radiograph, routine blood analysis, polysomnography, tilt table testing, 2-dimensional transthoracic echocardiography, nuclear or echocardiographic stress testing, and 24-hour Holter monitoring. All 3 patients had an abnormal response to head-up tilt table testing, with either a significant decrease in systolic blood pressure or inappropriate heart rate response on achieving an upright position. These observations together with our review of the literature suggest that gelastic syncope may be a variant of vasodepressor syncope. Knowledge of this condition, its pathophysiology, and potential treatment options may be of value to clinicians when evaluating patients with unexplained loss of consciousness.
晕厥是一种常见的主诉，通常在未确定诱发原因的情况下进行评估。发笑诱导性晕厥是一种不常见且了解甚少的病症。我们描述了 3 名在剧烈大笑时发生意识丧失的患者。每位患者都接受了广泛的医学评估，包括详细的病史和体格检查、12 导联心电图、胸部 X 光片、常规血液分析、多导睡眠图、倾斜台试验、二维经胸超声心动图、核素或超声心动图应激试验以及 24 小时动态心电图监测。这 3 名患者的直立倾斜台试验均出现异常反应，表现为达到直立位时收缩压显著下降或心率反应不当。这些观察结果以及我们对文献的回顾表明，发笑诱导性晕厥可能是血管抑制性晕厥的一种变体。当评估不明原因意识丧失的患者时，了解这种病症及其病理生理学和潜在治疗选择可能对临床医生有价值。
