Neurocardiogenic Sycope on Video-EEG and EKG: Two Cases Mimicking Seizures.
Abstract number :
2.137
Submission category :
Year :
2000
Submission ID :
1225
Source :
www.aesnet.org
Presentation date :
12/2/2000 12:00:00 AM
Published date :
Dec 1, 2000, 06:00 AM
Authors :
Tatiana Maleeva, William Sutherling, Lawrence Richman, Robert Cowan, Roger L Huf, Susan Garcia, Pat Glennon, Nancy Lopez, Doreen K Plehn, Barbara Miller, Gian Carla Quiroga, Huntington Epilepsy and Brain Mapping Program, Pasadena, CA; Huntington Medical R
RATIONALE: A common differential diagnostic problem occurs in patients with symptoms suggesting both seizures and cardiogenic syncope. We recently have evaluated three patients who had recurrent episodes with symptoms suggestive of seizures who were proven by VideoEEG to have neurocardiogenic syncope. We report here two of these patients who had transient asystole and electrocerebral silence during typical episodes. METHODS: The first patient was a 35 year old female with episodes of loss of consciousness while supine, clonic head jerking, consistent tongue biting, and urinary and fecal incontinence. Routine EEGs, CT scan, Holter monitor, and neurological exam were nondiagnostic. The second patient was a 33 year old man diagnosed with seizures and treated with antiepileptic medications intermittently for 24 years with recurrent symptoms of loss of consciousness, left hand shaking, and after the event a dreamy state. Routine EEG, MRI, Holter monitor, and neurological exam were normal. RESULTS: In the first patient, VideoEEG captured an episode with asystole for 20 seconds, EEG slowing 7 seconds after asystole, isoelectric EEG for 35 seconds and subsequent EEG slowing for 20 seconds. She responded to beta blockers. In the second patient, Video-EEG captured an event during sphenoidal electrode placement. There was asystole for about 20 seconds, EEG slowing 5 seconds after asystole, isoelectric EEG for 20 seconds and subsequent EEG slowing for 20 seconds. He responded to Norpace. Both patients had subsequent cardiac studies confirming neurocardiogenic syncope. CONCLUSIONS: The occurrence of tongue biting, prolonged lateralized shaking, and dreamy state are symptoms suggestive of seizures. These cases illustrate such symptoms during acute, diffuse cerebral ischemia. The Video-EEG is useful to exclude other processes and to record the semiology and polygraphic variables during an episode. In these cases, the VEEG had a higher yield than the Holter. Due to the presence of false positives of the tilt-table test, and to the occurence of both seizures and syncope in the same patient, Video-EEG with EKG monitoring may be useful for diagnosis in atypical cases.