Cardiogenic syncope and epilepsy: how not to make a mistake in the diagnosis. Clinical case and current of the issue status

Authors: E.V. Gordeeva1 2, N.V. Kizhvatova1 2, E.D. Kosmacheva1 2, L.V. Timchenko1, V.A. Porkhanov1 2

Company: 1 Scientific Research Institution – Professor S.V. Ochapovsky Region Clinical Hospital No 1, Krasnodar, 350086, Russian Federation
2 Kuban State Medical University, Krasnodar, 350063, Russian Federation

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Type:  Case reports


DOI: https://doi.org/10.24022/1997-3187-2020-14-2-178-187

For citation: Gordeeva E.V., Kizhvatova N.V., Kosmacheva E.D., Timchenko L.V., Porkhanov V.A. Cardiogenic syn- cope and epilepsy: how not to make a mistake in the diagnosis. Clinical case and current of the issue status. Creative Cardiology. 2020; 14 (2): 178–87 (in Russ.). DOI: 10.24022/1997-3187-2020-14-2-178-187

Received / Accepted:  12.05.2020 / 21.05.2020

Keywords: syncope cardiogenic syncope rhythm disturbances epilepsy sudden death

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Abstract

Syncopal conditions accompanied by convulsive syndrome are fairly frequent clinical situations that require a thorough examination and differential diagnosis of epilepsy with other, including cardiac, diseases that cause cerebral hypoperfusion. Risk stratification is fundamental in the management, and assessment of high-risk clinical symptoms should be carried out both at the first visit and at repeated contact with patient, provided that the symptoms persist. Here we present a clinical case of a transient complete atrioventricular block that manifested itself in the form of a loss of consciousness, accompanied by convulsive attack, which caused misdiagnosis of epilepsy and prolonged ineffective administration of anticonvulsants. The symptoms were eliminated by the implantation of a pacemaker. The discussion provides an algorithm for the differential diagnosis of syncope accompanied by seizures and cardiogenic syncope. In turn, an epileptic seizure can be accompanied by both benign, reversible rhythm disturbances, often sinus tachycardia, and prognostically unfavorable ones: ventricular fibrillation and bradycardia / asystole. It is considered that fatal cardiac arrhythmia is a cause of sudden death in epilepsy. The article presents the possible mechanisms for the development of such complications and the principles of patient management.

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About Authors

Elena V. Gordeeva, Cand. Med. Sc., Functional Diagnostician of Region Clinical Hospital # 1, Assistant Professor of Kuban State Medical University, orcid.org/0000-0003-4048-5308
Natal’ya V. Kizhvatova, Cand. Med. Sc., Head of Cardiology Department # 3 of Region Clinical Hospital # 1, Associate Professor of Department of Therapy # 1 of Kuban State Medical University, orcid.org/0000-0003-1477-5061
Elena D. Kosmacheva, Dr. Med. Sc., Professor, Deputy Chief Physician of Region Clinical Hospital # 1, Chief Cardiologist of the Southern Federal District and Krasnodar Territory, Head of Therapy Department # 1 of Kuban State Medical University, orcid.org/0000-0001-8600-0199
Lyudmila V. Timchenko, Head of Department, orcid.org/0000-0001-6341-0101
Vladimir A. Porkhanov, Dr. Med. Sc., Professor, Academician of RAS, Chief Physician of Region Clinical
Hospital # 1, Honored Doctor of the Russian Federation, Chief Thoracic Surgeon of the Krasnodar Territory, Chief of Chair of Oncology with a Course of Thoracic Surgery of Kuban State Medical University, orcid.org/0000-0003-0572-1395

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery