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[70-year-old patient with convulsive syncope].

Thomas Hügle1, Claudio Städler, Andreas Cerny

  • 1Abteilung für Innere Medizin, Ospedale Regionale di Lugano, Switzerland. hueglet@guhbs.ch

Medizinische Klinik (Munich, Germany : 1983)
|October 19, 2004
PubMed
Summary

Carotid sinus syndrome can cause convulsive syncope, especially in elderly patients with cardiovascular conditions. Early diagnosis is crucial due to contributing factors like heart disease and hypertension.

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Area of Science:

  • Cardiology
  • Neurology
  • Geriatrics

Background:

  • Syncope is a common cause for emergency department visits with a wide differential diagnosis.
  • Convulsive syncope is often misdiagnosed as epilepsy, but can result from cerebral hypoperfusion in any syncope type.
  • In elderly patients with cardiovascular disease, neurocardiogenic causes like carotid sinus syndrome are important considerations.

Observation:

  • Carotid sinus massage in an elderly patient provoked sinus bradycardia with a 2.2-second pause.
  • This event was immediately followed by a convulsive syncope.

Findings:

  • The patient's presentation suggests inhibitory carotid sinus syndrome.
  • A cardiac pause of less than 3 seconds was observed, which is shorter than typically required for diagnosis.
  • Contributing factors like coronary heart disease, arteriosclerosis, heart failure, and antihypertensive therapy likely precipitated early symptoms.

Implications:

  • This case highlights the multifactorial nature of syncope in the elderly.
  • It emphasizes the need to consider carotid sinus syndrome even with shorter cardiac pauses in predisposed individuals.
  • Early identification and management of contributing factors are essential for preventing recurrent syncope and associated injuries.

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