From the Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland and
From the Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland and.
QJM. 2015 Sep;108(9):711-8. doi: 10.1093/qjmed/hcv005. Epub 2015 Jan 27.
The prevalence of focal neurology (FN) as a consequence of syncope is unknown. The aim of the study was to determine its prevalence, risk factors and short-term consequences.
A consecutive sample of syncope-unit attendees during a 9-month period had detailed diagnostic syncope evaluation as per European Cardiac Society guidelines coupled with assessment for FN present during syncope/pre-syncope by screening questionnaire, follow-up interview and neuroimaging (1.5T magnetic resonance imaging [MRI]). All participants were followed up for 24 months. Risk factors for FN were identified by comparing FN cases with syncope controls without FN (3:1 ratio).
Five-hundred and forty consecutively attended for investigation of syncope (n = 401) and pre-syncope (n = 139). Thirty-one (5.7%) had FN events during hypotensive symptoms, mean age 49 years (19-85). The majority of FN cases had vasovagal syncope (VVS); 22 (71%), whereas eight had OH (25.8%) and one (3.2%) had cardiac arrhythmia. Median duration of FN was 15 min (IQR: 34.5). MRI in 28 (90%) was normal and in 3, old cerebral infarction was evident. Risk factors for FN/syncope were frequent syncope (P = 0·008), childhood syncope (P < 0.0005) and delayed diastolic recovery during active stand (P = 0·02). During 24-month follow-up and targeted intervention, no patients developed recurrence of FN.
One in 20 patients with syncope/pre-syncope have co-extant FN, which during 24-month follow-up, does not progress to a persistent deficit (>24 h). Awareness of co-occurrence of FN and syncope is important as stroke misdiagnosis results in aggressive anti-hypertensive management and future events may ensue.
晕厥导致局灶性神经功能障碍（FN）的患病率尚不清楚。本研究旨在确定其患病率、危险因素和短期后果。
在 9 个月的时间里，连续对晕厥单元的就诊者进行了详细的诊断性晕厥评估，根据欧洲心脏病学会指南进行，并通过筛查问卷、随访访谈和神经影像学（1.5T 磁共振成像 [MRI]）评估晕厥/晕厥前期间是否存在 FN。所有参与者均随访 24 个月。通过比较 FN 病例与无 FN 的晕厥对照（3:1 比例），确定 FN 的危险因素。
540 例连续就诊接受晕厥（n = 401）和晕厥前（n = 139）评估。31 例（5.7%）在低血压症状期间出现 FN 事件，平均年龄 49 岁（19-85 岁）。大多数 FN 病例为血管迷走性晕厥（VVS）；22 例（71%），8 例为 OH（25.8%），1 例为心律失常（3.2%）。FN 的中位持续时间为 15 分钟（IQR：34.5）。28 例（90%）的 MRI 正常，3 例有陈旧性脑梗死。FN/晕厥的危险因素为频繁晕厥（P = 0·008）、儿童期晕厥（P < 0.0005）和主动站立时舒张期恢复延迟（P = 0·02）。在 24 个月的随访和靶向干预期间，没有患者出现 FN 复发。
20 例晕厥/晕厥前患者中，有 1 例同时存在 FN，在 24 个月的随访中，不会进展为持续缺陷（>24 小时）。FN 和晕厥同时发生的意识很重要，因为中风误诊会导致积极的降压治疗，未来可能会出现其他事件。
