El Otmani H, Moutaouakil F, Fadel H, Slassi I
Service de neurologie, CHU Ibn-Rochd, Casablanca, Maroc; Service de neurologie, hôpital Al-Kortobi, Tanger, Maroc.
Rev Med Interne. 2012 Sep;33(9):522-4. doi: 10.1016/j.revmed.2012.06.004. Epub 2012 Jun 28.
Laughter-induced syncope or gelastic syncope is a rare and unrecognized phenomenon. We report an additional case.
We report a 65-year-old man with no personal past medical history, particularly diabetes or heart disease, was admitted to investigate recent four episodes of loss of consciousness exclusively induced by laugh. The first episode had occurred 8 months earlier after reading a funny story. There were no other symptoms and physical examination, particularly neurological and cardiac was normal. All paraclinical investigations were also unremarkable: laboratory tests (glucose, thyroid function test and blood cobalamin level), cardiac and neurological investigations (electrocardiographic monitoring, echocardiography, electroencephalography and brain MRI). Treatment with propanolol prevented subsequent attacks.
Sustained laugh is accompanied by repetitive bursts of forced expiration, equivalent to short repetition of Valsalva maneuvers. Laughter-induced syncope is thought to be a subtype of the vagal mediated syncopal attacks. Differential diagnosis should rule out especially gelastic atonic seizures and cataplexy. Propanolol is an effective therapy to prevent recurrence.
笑性晕厥或癔病性晕厥是一种罕见且未被充分认识的现象。我们报告另外一例病例。
我们报告一名65岁男性，既往无个人病史，尤其无糖尿病或心脏病史，因近期四次仅由大笑诱发的意识丧失入院检查。首次发作于8个月前，在阅读一个有趣故事后。无其他症状，体格检查，尤其是神经系统和心脏检查均正常。所有辅助检查也无异常：实验室检查（血糖、甲状腺功能检查和血液钴胺素水平）、心脏和神经系统检查（心电图监测、超声心动图、脑电图和脑部磁共振成像）。使用普萘洛尔治疗预防了后续发作。
持续大笑伴有反复的用力呼气发作，相当于短时间重复瓦尔萨尔瓦动作。笑性晕厥被认为是迷走神经介导的晕厥发作的一种亚型。鉴别诊断应特别排除癔病性无张力发作和猝倒症。普萘洛尔是预防复发的有效疗法。
