Department of Clinical Neurophysiology, Royal Hallamshire Hospital, Sheffield, UK.
Epilepsy Behav. 2011 Mar;20(3):450-3. doi: 10.1016/j.yebeh.2010.12.013. Epub 2011 Feb 15.
The pathophysiology of stretch syncope is demonstrated through the clinical, electrophysiological, and hemodynamic findings in three patients. Fifty-seven attacks were captured by video/EEG monitoring. Simultaneous EEG, transcranial (middle cerebral artery) doppler, and continuous arterial pressure measurements were obtained for at least one typical attack of each patient. They all experienced a compulsion to precipitate their attacks. Episodes started with a stereotyped phase of stretching associated with neck torsion and breath holding, followed by a variable degree of loss of consciousness and asymmetric, recurrent facial and upper limb jerks in the more prolonged episodes. Significant sinus tachycardia coincided with the phase of stretching and was followed within 9-16 seconds by rhythmic generalized slow wave abnormalities on the EEG in attacks with impairment of consciousness. Transcranial doppler studies showed a dramatic drop in cerebral perfusion in the middle cerebral arteries during the episodes. The combination of the stereotyped semiology of the attacks, the pseudofocal myoclonic jerking, and the rhythmic generalized slow wave EEG abnormalities with the tachycardia make differential diagnosis from epilepsy challenging.
通过三例患者的临床、电生理和血流动力学发现，展示了伸展性晕厥的病理生理学。视频/脑电图监测捕捉到 57 次发作。对每位患者的至少一次典型发作进行了同步脑电图、经颅（大脑中动脉）多普勒和连续动脉压测量。他们都经历了促使发作的冲动。发作开始于与颈部扭转和屏气相关的伸展的刻板阶段，随后是不同程度的意识丧失，在持续时间较长的发作中出现不对称、反复的面部和上肢抽搐。显著的窦性心动过速与伸展阶段同时发生，随后在 9-16 秒内，意识障碍发作的 EEG 上出现节律性广泛慢波异常。经颅多普勒研究显示，在发作期间大脑中动脉的脑灌注明显下降。发作的刻板半侧体征、假性局灶性肌阵挛抽搐以及节律性广泛慢波 EEG 异常与心动过速相结合，使得与癫痫的鉴别诊断具有挑战性。
