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A case of being scared to death
Archives of Internal Medicine
|September 1, 1983
Summary
A student experienced seizures triggered by images of human suffering. Monitoring revealed cardiac asystole and bradycardia, resolved by pacemaker implantation.
Area of Science:
- Neurology
- Cardiology
- Psychophysiology
Background:
- Generalized tonic-clonic seizures can have diverse and unusual triggers.
- Understanding the interplay between psychological stimuli and physiological responses is crucial for diagnosing complex cases.
Observation:
- A 21-year-old student presented with seizures induced by mental imagery of human pain.
- During EEG and ECG monitoring, exposure to a distressing passage induced asystole and a generalized tonic-clonic seizure.
- Ambulatory monitoring revealed progressive sinus bradycardia and atrioventricular block.
Findings:
- The patient experienced a 25-second asystole followed by electrocerebral silence and seizure activity.
- Sinus node and sinoatrial conduction times were normal during atrial pacing.
- Permanent pacemaker implantation rendered the patient asymptomatic.
Implications:
- This case highlights the importance of recreating specific trigger circumstances during diagnostic monitoring for unexplained loss of consciousness.
- Psychologically induced cardiac events and seizures can be effectively managed with appropriate interventions.
- Integrated EEG and ECG monitoring is valuable for elucidating complex ictal phenomena.