[70-year-old patient with convulsive syncope].
BACKGROUND
Syncope is a frequent reason for hospital admissions or emergency department visits with a broad differential diagnosis. Convulsive syncope is often falsely interpreted as an epileptic disorder. However, due to cerebral hypoperfusion, all forms of syncope can be associated with convulsions. In elderly patients with coronary heart disease or hypertension, "neurocardiogenic" causes, especially the carotid sinus syndrome, should be searched for. In general, cardiac pauses > or = 3 s after massage of the carotid sinus are required for the diagnosis of inhibitory carotid sinus syndrome.


METHODS
In the patient presented here, massage of the right carotid sinus provoked sinus bradycardia with pauses of 2,2 s and subsequent convulsive syncope.


CONCLUSIONS
Additive factors such as coronary heart disease, arteriosclerosis, heart failure, and antihypertensive therapy may result in early symptoms of the inhibitory carotid sinus syndrome. This underlines the multifactorial pathogenesis of syncope, especially in the elderly patient.
Abteilung für Innere Medizin, Ospedale Regionale di Lugano, Switzerland. hueglet@guhbs.ch
Thomas
T
Hügle
Claudio
C
Städler
Andreas
A
Cerny
D000367:Age Factors; D000368:Aged; D001919:Bradycardia / Q000209:etiology; D002340:Carotid Artery Diseases / Q000175:diagnosis; D002346:Carotid Sinus / Q000503:physiopathology*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D004569:Electroencephalography; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008405:Massage; D017202:Myocardial Ischemia / Q000150:complications; D010138:Pacemaker, Artificial; D012640:Seizures / Q000209:etiology*; D013575:Syncope / Q000175:diagnosis / Q000209:etiology*; D013577:Syndrome; D013997:Time Factors