[Micturition syncope: a peculiar cause of diagnostic doubt]

A 22-year old healthy man lost consciousness during urination in standing after night's sleep. He fell down to the floor without convulsions. A physician present by chance found on bradycardia. A 24-hours ECG monitoring disclosed an almost permanent sinus bradycardia (50-55 per minute). CT showed an arachnoid cyst at the base of the left temporal lobe without mass effect. In EEG only single slow waves above left temporal region were revealed. It seems, the cyst was found by chance and had no any pathogenetic relevance to the syncope. However, the presence of a structural change of the brain had not been described in micturition syncope till now and this makes careful differentiation from epileptic seizure essential. During the following 2 years the patient was well and the episode did not recur again. The control CT and EEG remained unchanged. Data from literature about syncope in association with micturition also in older persons, in majority women with chronic illnesses, are cited.