Cases reported "Syncope, Vasovagal"

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1/15. Valsalva-induced syncope during apnea diving.

    A young man had two dangerous episodes of transient loss of consciousness during apnea diving in a swimming pool. Medical and neurologic examination results were normal. Standard autonomic test results (including heart rate variability, baroreflex sensitivity, tilt-table test, and Valsalva ratio) were unremarkable, with the exception of an increased blood pressure decrease during early phase II of the valsalva maneuver. syncope with arrhythmic myoclonic jerks could be evoked by a strong straining maneuver. Simultaneous physiologic recordings showed extreme blood pressure and cerebral blood flow velocity decreases and electroencephalographic slowing during syncope. The electrocardiogram showed a continuous sinus rhythm with a progressive tachycardia. The authors' findings were not compatible with baroreflex failure or vasovagal mechanisms (Bezold-Jarisch reflex activation) as the underlying causes. The authors concluded that mechanical factors (strong reduction of blood reflux to the heart) in combination with a reduced threshold of the brain for developing ischemia-related arrhythmic myoclonic jerks were responsible for Valsalva-induced syncope in the patient.
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2/15. Vasovagal syncope: a new treatment for an old problem.

    Vasovagal syncope is an extremely common condition that is most often benign. However, in some individuals it can be far more severe, with frequent, sudden, and prolonged episodes of loss of consciousness. The effects can be traumatic, not only from the acute event but from the lifestyle changes that are necessitated by these attacks. We report on the presentation and diagnosis of once such individual and discuss the various treatment options. In addition, supported by recently published evidence, we demonstrate how a pacemaker with rate-drop response is an effective form of treatment.
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3/15. Neurocardiogenic syncope in a 10-year-old boy.

    We present a case with a suspected epileptic disorder. This may be a result of a neurocardiogenic syncope leading to seizures. A 10-year-old boy suffered two episodes of sudden loss of consciousness after getting injections. electrocardiography (ECG) and electroencephalography recordings during a venipuncture showed asystole of 6 seconds followed by a generalized seizure with clonic jerks of the right arm and leg while theta waves in the EEG were noted. Tilt-table testing could not provoke a pathological reaction.
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4/15. Cerebral syncope in a patient with spinal cord injury.

    An 80-year-old patient suffering from traumatic paraplegia due to spinal cord compression was admitted due to recurrent orthostatic syncope. Tilt table testing revealed that the patient lost consciousness without hypotension. Doppler flow measurements of the middle cerebral arteries showed a significant decrease in diastolic velocity during syncope without systemic hypotension. Treatment with beta-blockers was highly effective. The patient suffered from cerebral blood flow disregulation probably due to abnormal baroreceptor responses triggered during orthostatic stress. This is the first reported case of a patient with spinal cord injury suffering from such an unusual cause of syncope.
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5/15. Vasovagal syncope masquerading as unexplained falls in an elderly patient.

    The authors report the case of a 78-year-old woman who had recurrent, unexplained falls. No witness account of these episodes was available. During head-up tilt testing, the patient had vasodepressor vasovagal syncope. Afterwards, she had amnesia from loss of consciousness. Her symptoms (falls) responded to the withdrawal of culprit medications.
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6/15. Decreased bispectral index as an indicator of syncope before hypotension and bradycardia in two patients with needle phobia.

    We report two cases who exhibited a decrease in their bispectral index (BIS) score, associated with syncope during venipuncture in patients with suspected needle phobia. In case 1, the reduction in BIS score occurred during the development of hypotension and bradycardia and may well have been caused by cerebral hypoperfusion. In case 2, the patient lost consciousness with decreasing BIS score before hypotension and bradycardia; this patient's condition could not be completely explained by cerebral hypoperfusion as a result of a vasovagal reflex because the patient's blood pressure and heart rate remained normal during the syncopal episode.
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7/15. Vasovagal syncope interrupting sleep?

    Clinical data are reported for 13 patients who were referred with recurrent loss of consciousness at night interrupting their sleep. Most of the patients were women (10 of 13) with a mean age of 45 years (range 21-72 years). The histories were more consistent with vasovagal syncope than with epilepsy. This was supported by electroencephalographic and tilt test results. More polysomnographic monitoring data are required to confirm the diagnosis of vasovagal syncope interrupting sleep. This will be difficult because, although the condition may not be rare, the episodes are usually sporadic.
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8/15. Neurocardiogenic syncope: a case of prolonged asystole.

    We report the case of a 48-year-old woman with frequent episodes of loss of consciousness. The patient was submitted to head-up tilt testing that evoked a prolonged asystole associated with sphincteric incontinence and loss of urine. The patient was treated with dual-chamber pacemaker implantation; at a follow-up of 18 months no other episodes of syncope had occurred.
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9/15. Can memories kindle nonconvulsive behavioral seizures in humans? Case report exemplifying the "limbic psychotic trigger reaction".

    We present three hypotheses-(1) the limbic psychotic trigger reaction (LPTR) is a form of nonconvulsive behavioral seizures (NCBS), (2) kindling may occur in the LPTR, and (3) kindling may occur with memory stimuli-and report a case that may exemplify a LPTR kindled by memory and triggered by light and smell. The LPTR has a primate model, in which NCBS are kindled by intermittent exposure to actual subthreshold stimuli. In humans, we propose that such triggering stimuli can be revived by memory alone. Thus, individualized stimuli can trigger partial limbic seizures or seizure-like bizarre episodes with a transient loss of frontal control functions. We present a case of paroxysmal episodes of out-of-character, bizarre, unplanned nonvoluntary acts that occurred with flat affect and without drive motivation (e.g., "fire setting"). Implicated is a transient state of limbic "paleo-consciousness" with preserved memory, autonomic arousal, and first-time brief psychosis (e.g., olfactory, visual hallucinations and depersonalization with olfactory attributes). As in kindled primates, LPTR patients do not show a consistent pattern of morphological brain abnormality; half have had an abnormal electroencephalogram, computed tomography scan, or magnetic resonance image at some time during their lives, and half (including the new patient) have had closed head injuries.
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10/15. Vasovagal syncope evoked by needle phobia when inserting a contact lens.

    PURPOSE: To report a patient who fell unconscious because of vasovagal syncope evoked by needle phobia when he tried to wear contact lenses. case reports: A 16-year-old healthy boy had sometimes experienced dizziness when looking at the tips of pens. When he put his finger and the lens close to his eye to insert a soft contact lens, he felt sick and dizzy and fell unconscious. CONCLUSION: Our experience suggests that patients with needle phobia may develop vasovagal syncope by concentrating on a fingertip when inserting a contact lens. We need to be aware of unconsciousness because of phobia when trying to insert contact lenses.
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