title: [Neurally mediated syncope with significant cardiac arrest and asymptomatic multiple cerebral infarctions: a case report].
abstract: A 32-year-old man had suffered episodes of loss of consciousness since childhood. He was admitted to another hospital because of three syncopal episodes in one day. He was referred to our hospital because of asymptomatic multiple lacunae indicating cerebral infarction on magnetic resonance imaging. He lost consciousness with convulsion followed by a 70-second interval of cardiac arrest during blood sampling. He reported the onset of his usual prodromal symptoms after 1 min in the 80 degrees head-up tilt position. He lost consciousness 2 min after returning to the supine position. Electrocardiography demonstrated a 10-second interval of cardiac arrest. Magnetic resonance angiography, carotid arterial echography, brain perfusion scintigraphy, and laboratory chemistry and hematology examinations identified no significant findings. Cerebral infarction had occurred in watershed areas, so hemodynamic change during cardiac arrest may be the main cause of the infarctions. He suffered no further syncopal or presyncopal episodes after implantation of a DDD pacing system.
authors.affiliation: Second Department of Internal Medicine, Yokohama City University School of Medicine, Fukuura 3-9, Kanazawa-ku, Yokohama 236-0004. koheimat@ya2.so-net.ne.jp
authors.forename: Kohei
authors.initials: K
authors.lastname: Matsushita
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Shinichi
authors.initials: S
authors.lastname: Sumita
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Kobayashi
authors.forename: Noriko
authors.initials: N
authors.lastname: Kawasaki
authors.forename: Katsumi
authors.initials: K
authors.lastname: Matsumoto
authors.forename: Minoru
authors.initials: M
authors.lastname: Taima
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ishigami
authors.forename: Teruyasu
authors.initials: T
authors.lastname: Sugano
authors.forename: Ichiro
authors.initials: I
authors.lastname: Nakazawa
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Ogawa
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Uchino
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology; D002544:Cerebral Infarction / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D004562:Electrocardiography; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010138:Pacemaker, Artificial; D019462:Syncope, Vasovagal / Q000209:etiology* / Q000628:therapy*