Iniesta Ivan, Yotti Raquel, Garcia-Pastor Andres
The Walton Centre for Neurology and Neurosurgery, Neurology, Lower Lane, Fazakerley, Liverpool L9 7LJ, UK.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.06.2008.0285. Epub 2009 Mar 20.
The differential diagnosis of syncope versus seizures represents a daily challenge for cardiologists and neurologists. Long Q-T syndrome and hypertrophic cardiomyopathy (HCM) are two hereditary arrhythmogenic heart conditions causing syncope in early adulthood. We report the cases of two patients who were reassessed for transient loss of consciousness (TLOC) with convulsions despite treatment. The first patient, a 40-year-old woman, had been diagnosed with epilepsy and was given phenytoin. Her episodes took place while swimming or when in emotional distress and were not followed by post-ictal confusion. An electrocardiogram showed a very prolonged Q-Tc interval. The second patient, a 30-year-old man with HCM in whom a defibrillator had been implanted on the assumption that he was having cardiogenic syncopes, was actually found to have epilepsy. Adequate treatment rendered both patients asymptomatic. In conclusion, the clinical history and 12-lead electrocardiography remain crucial in the management of TLOC, ideally involving both cardiologists and neurologists.
晕厥与癫痫的鉴别诊断是心脏病专家和神经科医生每天都要面对的挑战。长QT综合征和肥厚型心肌病（HCM）是两种遗传性致心律失常性心脏病，可在成年早期导致晕厥。我们报告了两名患者的病例，尽管经过治疗，但仍因抽搐性短暂意识丧失（TLOC）而接受重新评估。第一名患者是一名40岁女性，曾被诊断为癫痫，并服用苯妥英钠。她的发作发生在游泳时或情绪困扰时，发作后没有出现发作后意识模糊。心电图显示QTc间期非常延长。第二名患者是一名30岁男性，患有HCM，因被认为有心源性晕厥而植入了除颤器，但实际上被发现患有癫痫。充分的治疗使两名患者均无症状。总之，临床病史和12导联心电图在TLOC的管理中仍然至关重要，理想情况下需要心脏病专家和神经科医生共同参与。
