Arrhythmogenic syncope in a "neurologic" patient. The need for a multidisciplinary approach.
Year: 2008
Type: article
Study design: Case Report
Abstract: An 81-year-old female patient was admitted to the emergency department because of recurrent episodes of loss of consciousness and seizures. Based on her history of ischaemic stroke and hypertension, she was examined by a neurologist. Urgent cerebral computed tomography was performed and the occurrence of a haemorrhagic event was excluded. During cardiologic consultation, an electrocardiogram in sinus rhythm with bifascicular heart block (right bundle branch and left anterior hemiblock) was recorded, while cardiac auscultation, chest X-ray and biochemical markers revealed no significant findings. The patient was hospitalized in the neurology department, where at least three new episodes occurred in the following two days. Rest and provocative electroencephalogram were performed, and no pathologic waves were recorded. The neurologists, thereafter, asked for a second cardiac consultation. Echocardiographic findings were not indicative of cardiogenic syncope. A 24-hour ECG Holter was also performed. During ambulatory ECG recording, a new episode of seizures was documented by nursing staff while the patient was sleeping. Holter analysis revealed episodes of ventricular asystole, complete AV block with slow escape ventricular rhythm, and self-terminated torsade de pointes (Fig. 1), which chronically coincide with the aforementioned event. Although exaggerated bradycardia may accompany an epileptic seizure [1],
Source: PubMed
Institutions: Hellenic Red Cross, Red Cross Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2143563629