The semiology of tilt-induced psychogenic pseudosyncope
The semiology of tilt-induced psychogenic pseudosyncope
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DOI：
10.1212/wnl.0b013e3182a1aa88
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发表时间：
2013-08-20
期刊：
影响因子：
9.9
通讯作者：
van Dijk, J. Gert
中科院分区：
文献类型：
--
作者：
Tannemaat, Martijn R.;van Niekerk, Julius;van Dijk, J. Gert
目的：提供详细的症状学，以帮助临床识别心因性假性晕厥 (PPS)，该症状涉及模仿晕厥的明显短暂性意识丧失 (TLOC) 发作。方法：我们分析了 2006 年至 2012 年的所有连续倾斜台测试，显示经过验证的 PPS，即，在没有 EEG 变化或心率 (HR) 或血压 (BP) 下降的情况下发生了明显的 TLO Chad。我们分析了 1 秒时间尺度的基线特征、视频数据、EEG、ECG 和连续血压测量。将数据与 69 例倾斜引起的血管迷走性晕厥 (VVS) 病例的数据进行比较。结果：在 800 例倾斜台测试中，43 例 (5.4%) 导致 PPS。大多数（74%）是女性。 PPS 中表观 TLOC 的中位持续时间（44 秒）比 VVS 中（20 秒，p < 0.05）更长。事件期间，PPS 中 97% 的人闭眼，但 VVS 中只有 7% 的人闭眼 (p < 0.0001)。与 VVS 相比，PPS 中突然头部下降或沿倾斜台移动的情况更常见 (p < 0.01)，但 VVS 中更频繁发生抽搐动作 (p < 0.0001)。在 PPS 中，心率和血压在明显 TLOC 之前和期间均增加 (p < 0.0001)。 结论：PPS 在临床上与 VVS 不同，可以通过倾斜台测试和同时 EEG 监测准确诊断。与 VVS 相比，事件期间闭眼、长时间明显 TLOC 以及高 HR 和 BP 对 PPS 具有高度特异性。提高对 PPS 作为临床实体的符号学的理解对于确保准确诊断至关重要。
Objectives: To provide a detailed semiology to aid the clinical recognition of psychogenic pseudosyncope (PPS), which concerns episodes of apparent transient loss of consciousness (TLOC) that mimic syncope.Methods: We analyzed all consecutive tilt-table tests from 2006 to 2012 showing proven PPS, i.e., apparent TLO Chad occurred without EEG changes or a decrease in heart rate (HR) or blood pressure (BP). We analyzed baseline characteristics, video data, EEG, ECG, and continuous BP measurements on a 1-second time scale. Data were compared with those of 69 cases of tilt-induced vasovagal syncope (VVS).Results: Of 800 tilt-table tests, 43 (5.4%) resulted in PPS. The majority (74%) were women. The median duration of apparent TLOC was longer in PPS (44 seconds) than in VVS (20 seconds, p < 0.05). During the event, the eyes were closed in 97% in PPS but in only 7% in VVS (p < 0.0001). A sudden head drop or moving down the tilt table was more common in PPS than in VVS (p < 0.01), but jerking movements occurred more frequently in VVS (p < 0.0001). In PPS, both HR and BP increased before and during apparent TLOC (p < 0.0001).Conclusions: PPS is clinically distinct from VVS and can be diagnosed accurately with tilt-table testing and simultaneous EEG monitoring. Compared with VVS, eye closure during the event, long periods of apparent TLOC, and high HR and BP are highly specific for PPS. Improved understanding of the semiology of PPS as a clinical entity is vital to ensure accurate diagnosis.