Oribe E, Amini R, Nissenbaum E, Boal B
Department of Medicine, Catholic Medical Center of Brooklyn and Queens, Jamaica, NY, USA.
Neurology. 1996 Jul;47(1):60-2. doi: 10.1212/wnl.47.1.60.
The distinction between syncope and epileptic seizures is a common clinical diagnostic problem. Elevated serum prolactin (PRL) concentrations are used to help differentiate epileptic from nonepileptic attacks such as pseudoseizures. Reports of PRL concentrations following syncope have been variable. To determine whether PRL rises after syncope, we measured serum PRL concentrations during a 45-minute passive 60-degree head-up tilt in 21 patients with a history of near-fainting or syncope. Head-up tilt triggered hypotension (mean arterial pressure 51 mm Hg, 95% CI = 45-57) with syncope in 11 patients. PRL concentrations were elevated ( > 19 ng/mL) and reached a maximum within the first 30 minutes after tilt-induced syncope in nine patients (PRL supine: 11 ng/mL, 95% CI = 7-15, vs. PRL after syncope: 52 ng/mL, 95% CI = 36-67; a greater than fourfold rise), while they remained unchanged in 10 patients who had a normal response to head-up tilt (PRL supine: 6 ng/mL, 95% CI = 5-8, vs. maximum PRL while upright: 8 ng/mL, 95% CI = 6-10). The findings indicate that elevated PRL concentrations are present after hypotensive syncope and are of little use in differentiating such syncope from epileptic seizures.
晕厥与癫痫发作的鉴别是常见的临床诊断问题。血清催乳素（PRL）浓度升高可用于帮助区分癫痫发作与非癫痫发作，如假性发作。关于晕厥后PRL浓度的报道并不一致。为了确定晕厥后PRL是否升高，我们对21例有接近晕厥或晕厥病史的患者进行了45分钟的被动60度头高位倾斜试验，并测量了血清PRL浓度。头高位倾斜引发了低血压（平均动脉压51 mmHg，95%可信区间=45-57），11例患者发生了晕厥。9例患者PRL浓度升高（>19 ng/mL），并在倾斜诱发晕厥后的前30分钟内达到最高值（仰卧位PRL：11 ng/mL，95%可信区间=7-15，与晕厥后PRL：52 ng/mL，95%可信区间=36-67相比；升高超过四倍），而10例对头高位倾斜反应正常的患者PRL浓度保持不变（仰卧位PRL：6 ng/mL，95%可信区间=5-8，与直立位时最高PRL：8 ng/mL，95%可信区间=6-10相比）。这些发现表明，低血压性晕厥后PRL浓度升高，在区分这种晕厥与癫痫发作方面作用不大。
