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Clinical data are reported for 13 patients who were referred with recurrent loss of consciousness at night interrupting their sleep. Most of the patients were women 10 of 13 with a mean age of 45 years range 21—72 years. The histories were more consistent with vasovagal iut than with epilepsy. This was supported by electroencephalographic and tilt test results. More polysomnographic monitoring data are required to confirm the diagnosis of vasovagal syncope interrupting sleep.
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Clinical data are reported for 13 patients who were referred with recurrent loss of consciousness at night interrupting their sleep. Most of the patients were women 10 of 13 with a mean age of 45 years range 21—72 years. The histories were more consistent with vasovagal syncope than with epilepsy. This was supported by electroencephalographic and tilt test results. More polysomnographic monitoring data are required to confirm the diagnosis of vasovagal syncope interrupting sleep.
This will be difficult because, although the condition may not be rare, the episodes are usually sporadic. When a patient complains of episodic loss of consciousness at night interrupting sleep, most physicians think of epilepsy as the likely diagnosis. The differential diagnosis includes sleep apnoea, sleep paralysis, hypoglycaemia, panic attacks, and cardiac arrhythmia.
Detailed histories were taken in an effort to ascertain the likely cause of these episodes, in particular whether the clinical features were suggestive of a vasovagal reaction starting during sleep. Patient 1 had her first nocturnal syncopal episode at the age of 40 years. After sleeping for some hours, she awoke and felt nauseous with abdominal discomfort and the urge to defecate. She lost consciousness while lying supine.
She sweated profusely but did not bite her tongue. Her husband observed transient myoclonic jerking. After this, similar episodes occurred regularly at least one a month and only at night.
The syncopal episodes never exceeded one minute and were atraumatic. She was incontinent of urine and faeces once. A tilt test provoked a vasovagal reaction followed by seven seconds of asystole and reproduced her nocturnal symptoms.
The EEG was judged normal by two independent neurologists. Simultaneous electroencephalographic EEG and cardiac recordings before and during typical nocturnal episode in patient 1. The montage consists of four sets of channels running anteriorly to posteriorly and recorded from the right parasagittal, left parasagittal, right temporal, and left temporal areas.
A Time 5. B Time 5. C Time 5. At this time the patient was pale and sweating profusely. Ten were women. The mean age was 45 years range 21—72 years. They all gave a history of waking up at night with nausea and urge to defecate. In some patients, syncope occurred in bed; Hot sleeping passed out others immediately after leaving the bed in an effort to get to the toilet. The syncope was of short duration and was often accompanied by profuse sweating. After http://mirandamustgo.info/valuable-workout-for-large-schlong.php consciousness most patients felt very weak and could абсолютно Black tgirl wanking while showing off her ass прошедшим remain upright but were orientated.
Bradycardia was documented in five patients. The frequency of attacks varied from weekly to annually and there was no relation to menstruation or alcohol. Three patients reported nightmares immediately before the episode. Some patients had learned to partially abort the episodes by remaining supine Hot sleeping passed out bed. Nine patients also had daytime syncopal and presyncopal episodes associated with vasovagal symptoms.
Eleven patients underwent tilt table testing without pharmacological provocation. The test was positive in seven with typical prodromal symptoms. The possibility of organic cardiac or cerebral pathology as a cause of Hot sleeping passed out episodes was excluded by appropriate additional testing. Interictal EEG performed in seven patients showed epileptiform activity in one patient We suggest that all of these patients may have nocturnal vasovagal syncope as the primary cause of their symptoms.
Although the attacks started when the patients were supine, the associated symptoms described were typical Hot sleeping passed out vasovagal syncope. These were nausea, sweating, lightheadedness, and abdominal discomfort during the attack, followed by tiredness and weakness afterwards.
Because the attacks occurred at night in bed, epilepsy was often initially diagnosed, especially if muscle jerking was observed. However, it should be realised that transient myoclonic jerking is more often a feature of cerebral hypoperfusion than of epilepsy. In addition to the nocturnal episodes, most of these вот ссылка had daytime vasovagal attacks in response to common triggers—for example, pain, the sight of blood, and prolonged standing in hot, crowded rooms.
It is most important to differentiate nocturnal syncope from atypical forms of epilepsy. For example, abdominal epilepsy is a rare form of complex partial seizure disorder affecting women of a similar age to those of our patients. Other types of complex partial seizures begin with transient upper abdominal discomfort and may be complicated by autonomic symptoms.
This paroxysmal activity may be more often seen during sleep. The mechanism for vasovagal syncope remains uncertain but probably involves transient inhibition of sympathetic outflow from the medulla in response to certain triggers such as orthostasis and fear. But there are several other possible mechanisms by which the brainstem may be transiently overridden: Finally, we emphasise that our findings are only preliminary and our data are incomplete. The diagnosis of episodic nocturnal conditions is difficult because the doctor does not usually ever see what happens during an event.
Taking an expert history and excluding other possibilities is a good start but does not prove the diagnosis. On the basis of our observations and limited data, we think that patients who have nocturnal loss of consciousness with classical vasovagal prodromal symptoms may have true vasovagal syncope. A history of daytime vasovagal syncope in response to typical triggers and a positive tilt table test can support this diagnosis. Most cardiac causes of nocturnal syncope, including repolarisation abnormalities, can be excluded by a normal ECG.
This will be difficult in view of the sporadic nature of the attacks in most patients. We suspect that this condition is not rare, despite the absence of previous reports. Doctors may discount the diagnosis of vasovagal syncope interrupting sleep because the concept does not Hot sleeping passed out with current physiological dogma. Patients may Hot sleeping passed out volunteer their nocturnal episodes for fear of being labelled epileptic or hysterical.
Doctors managing Hot sleeping passed out with recurrent vasovagal syncope who inquire specifically about nocturnal episodes may be reminded of patients with similar histories to those we have described.
The fact that these cases have not been previously reported is probably testimony to our lack of understanding, rather than the true incidence, of this condition. Source of support: Dr Wieling is the Hot sleeping passed out of an unrestricted educational grant from Medtronic Europe.
National Center for Biotechnology InformationU. Journal List Heart v. Author information Article notes Copyright and License information Disclaimer. Correspondence to: Accepted Jan This article has been cited by other articles in PMC. Abstract Clinical data are reported for 13 patients who were referred with recurrent loss of Hot sleeping passed out at night interrupting their sleep. Open in a separate window. Figure 1. Table 1 Patient demographic and clinical data.
Hopkins AP. Disorders of consciousness. Oxford textbook of medicine3rd ed. Oxford University Press, Guidelines on management diagnosis and treatment of syncope. Eur Heart J ; The vasovagal response. Clin Sci Lond ; Shneerson JM. Handbook of sleep medicine. Blackwell Science, Lempert T. Recognizing syncope. J R Soc Med ; Historical criteria that distinguish syncope from seizures.
J Am Coll Cardiol ; The spectrum of abdominal epilepsy in adults. Am J Gastroenterol ; Koutroumanidis M. Panayiotopoulos syndrome. BMJ ; Ann Neurol ; New insights into the mechanism of neurally mediated syncope.