Baratloo Alireza, Rouhipour Alaleh, Forouzanfar Mohammadmahdi, Rahmati Farhad, Hashemi Behrooz
Department of Emergency Medicine, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
Department of Pediatrics, Vali Asr Hospital, Ghazvin University of Medical Sciences, Abyek, IR Iran.
Trauma Mon. 2013 Dec;18(3):141-4. doi: 10.5812/traumamon.12016. Epub 2013 Oct 13.
A sudden loss of consciousness followed by abnormal movements can be ictal or syncopal in origin. Transient response by the brain to sudden decrease of blood flow may cause sudden loss of consciousness followed by abnormal movements that mimic seizure. Dysrhythmia is one of the important and critical reasons of such events that should be differentiated from seizure.
In this case report we describe a 55 year-old woman admitted to our emergency department first with the impression of seizure. Eventually, it was realized that she had suffered from brain hypo-perfusion secondary to hypokalemia induced arrhythmia. Her arrhythmia was managed by unsynchronized biphasic shock in acute phase and also potassium replacement. She was then admitted to the CCU (Coronary Care Unit) where she received further care for medical management and drug dose adjustment and was discharged 4 days later.
Syncope from arrhythmia most commonly results from ventricular tachycardia, which accounts for 11% of all cases of syncope. Torsades de point is a unique type of ventricular tachycardia, characterized by QRS complexes of changing amplitude proceeded by prolonged QT intervals and almost often followed by loss of consciousness and also seizure like movements. Prolonged QT interval which is an important provocative factor for torsades de point commonly results from interactions between drug therapy, myocardial ischemia, and electrolyte disturbances such as hypokalemia or hypomagnesaemia. Changes in the extracellular potassium level have predominant and profound influences on the function of the cardiovascular system that may provoke fatal demonstrations such as QT prolongation, ventricular arrhythmia and even cardiac arrest. Electrolyte assessment is particularly important in certain patient populations, such as the elderly in whom a variety of pathological states or conditions like dehydration or renal failure are more common. Early identification and correction of these disturbances are necessary to control either seizures or seizure-like movements and prevent permanent brain damage, as anticonvulsants alone are generally ineffective.
意识突然丧失并伴有异常运动，其起源可能是癫痫发作或晕厥。大脑对血流突然减少的短暂反应可能导致意识突然丧失，随后出现类似癫痫发作的异常运动。心律失常是此类事件的重要且关键原因之一，应与癫痫发作相鉴别。
在本病例报告中，我们描述了一名55岁女性，最初因癫痫发作的印象被收入我们的急诊科。最终发现她因低钾血症诱发的心律失常导致脑灌注不足。急性期通过非同步双相电击以及补钾对其心律失常进行了处理。随后她被收入冠心病监护病房（CCU），在那里接受了进一步的医疗管理和药物剂量调整护理，并于4天后出院。
心律失常导致的晕厥最常见于室性心动过速，占所有晕厥病例的11%。尖端扭转型室速是一种独特类型的室性心动过速，其特征为QRS波群振幅变化，之前有QT间期延长，几乎常伴有意识丧失及类似癫痫发作的运动。QT间期延长是尖端扭转型室速的一个重要诱发因素，通常由药物治疗、心肌缺血以及低钾血症或低镁血症等电解质紊乱之间的相互作用引起。细胞外钾水平的变化对心血管系统功能有主要且深远的影响，可能引发致命表现，如QT延长、室性心律失常甚至心脏骤停。电解质评估在某些患者群体中尤为重要，例如老年人，他们更易出现各种病理状态或情况，如脱水或肾衰竭。早期识别和纠正这些紊乱对于控制癫痫发作或类似癫痫发作的运动以及预防永久性脑损伤是必要的，因为仅使用抗惊厥药物通常无效。
