title: [Convulsive syncope associated with transient hemodynamic ischemia in the basal ganglia].
abstract: The pathophysiology of convulsive movements in patients with convulsive syncope remains unclear. Here, we report a patient with convulsive syncope whose convulsive movements seemed to be associated with transient hemodynamic ischemia in the basal ganglia. A 74-year-old man had 1-year history of orthostatic hypotension and transient clonic jerks in the limbs and trunk, predominantly in the right upper limb. His convulsive movements were evoked approximately 1 minute after sitting up or standing up from the supine position and lasted for several tens of seconds. He felt mild faint while the convulsive movements lasted, but he was oriented and could follow simple commands. He was diagnosed as pure autonomic failure. Video-electroencephalogram (EEG) recorded generalized slows without any epileptiform discharges when the symptoms appeared. Single-photon emission computed tomography (SPECT) was performed using split-dose method to evaluate the change in blood flow when the convulsive movements appeared. During symptoms, a significant decrease in blood flow was revealed in the anterior part of the left basal ganglia, bilateral frontal areas, and right cerebellar hemisphere. An alteration in the functional balance between the basal ganglia and the cerebral cortices may play a role in the generation of convulsive movements in patients with convulsive syncope.
authors.affiliation: Department of Neurology, Graduate School of Medicine, Kyoto University
authors.forename: Takashi
authors.initials: T
authors.lastname: Murahara
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Takaya
authors.forename: Daisuke
authors.initials: D
authors.lastname: Yamaguchi
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Tanaka
authors.forename: Hidenao
authors.initials: H
authors.lastname: Fukuyama
authors.forename: Akio
authors.initials: A
authors.lastname: Ikeda
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Takahashi
mesh_terms: D000368:Aged; D001479:Basal Ganglia / Q000098:blood supply*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000150:complications* / Q000503:physiopathology; D008297:Male; D013575:Syncope / Q000209:etiology* / Q000503:physiopathology