Stressful medical explanation may cause syncope in patients with emotion-triggered neurocardiogenic syncope
Stressful medical explanation may cause syncope in patients with emotion-triggered neurocardiogenic syncope
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压力性医学解释可能导致情绪引发的神经心源性晕厥患者晕厥
DOI：
10.1111/pace.13199
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Nakasato N
中科院分区：
文献类型：
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作者：
Kato K;Kakisaka Y;Jin K;Fujikawa M;Nakamura M;Suzuki N;Kondo M;Fukuda K;Shimokawa H;Nakasato N
致编辑：神经心性晕厥 (NCS) 是神经介导性晕厥 (NMS) 的一种形式。之前的报告表明，情绪压力增加是 NMS 的触发因素。然而，由情绪引发的 NCS 案例记录很少。 1 我们介绍了第二例由压力医学解释引发的 NCS 病例。一名 23 岁女性，从 11 岁起，每年因情绪压力引发反复“癫痫发作”2 至 3 次。她报告了不起眼的过去和家族史。她的癫痫发作始于自主神经症状，例如心悸和出汗过多，然后是抽搐。在之前的医院，反复进行脑电图（EEG）、脑磁共振成像和动态心电图（ECG）检查均未发现异常。她被转介到我们科室接受癫痫的综合评估。神经系统检查未见异常。长期视频脑电图记录了她在接受主任医师例行就诊时的习惯性癫痫发作。我们发现她癫痫发作之前有房室传导阻滞（AVB）引起的心脏停搏。脑电图显示心脏停搏后 6 秒普遍减慢，当她因抽搐失去知觉时，脑电活动随后完全停止（图 1）。视频脑电图和同步心电图监测证实她的癫痫发作为惊厥性晕厥。根据NCS的诊断，她的主治医生及时解释了她的诊断以及接下来转入重症监护室密切观察并可能紧急植入起搏器的计划。突然的医学解释引起的压力导致她因心脏骤停而失去知觉（图 2），心脏监测记录显示。进行平视倾斜检查以进行调查
To the Editor: Neurocardiac syncope (NCS) is a form of neurally mediated syncope (NMS). Previous reports have indicated increased emotional stress as a trigger of NMS. However, there are very few documented cases of emotion-triggered NCS. 1 We present a second case of NCS triggered by stressful medical explanation.A 23-year-old female started to have recurrent “seizures” elicited by emotional stress two or three times per year from the age of 11 years. She reported unremarkable past and family history. Her seizures started with autonomic symptoms, such as palpitation and excessive sweating, followed by convulsion. At a previous hospital, repeated electroencephalography (EEG), brain magnetic resonance imaging, and Holter electrocardiography (ECG) found no abnormalities. She was referred to our department to receive a comprehensive evaluation of epilepsy. Neurological examinations showed no abnormalities. Long-term video EEG captured her habitual seizure when she received a routine visit by the chief physician. We found that her seizure was preceded by cardiac asystole caused by atrioventricular block (AVB). EEG showed generalized slowing 6 seconds after the cardiac asystole, with sequential complete cessation of cerebral electrical activity when she lost consciousness with convulsion (Figure 1). Video EEG with simultaneous ECG monitoring clarified her seizure as convulsive syncope. Based on the diagnosis of NCS, her attending physician promptly explained her diagnosis and the following plan for transfer to the intensive care unit for close observation and possible emergent implantation of a pacemaker. The stress induced by the sudden medical explanation resulted in her losing consciousness due to cardiac arrest (Figure 2) as documented by cardiac monitoring. Head-up tilt examination performed for investigation