title: Presumed mitochondrial disease manifesting with recurrent syncopes.
abstract: OBJECTIVE
  Loss of consciousness may be due to neurological or cardiac involvement in mitochondrial disease, and is often difficult to attribute to either cause, as in the following case.
  
  
  METHODS
  A 67-year-old man with hypertension, diabetes, elevated serum creatine kinase, glaucoma, optic atrophy, and vertigo had experienced recurrent losses of consciousness since 63 years of age. Diagnostic work-up revealed paroxysmal supraventricular arrhythmias, hyperlipidemia, steatosis hepatis, renal insufficiency, polyneuropathy, first-degree atrio-ventricular block, orthostasis, and cataract. From the age of 66 years, he developed tonic-clonic seizures. Electrocardiography loop recording showed some losses of consciousness as associated with supraventricular tachycardias and others with epileptic activity or arterial hypotension. Neurological investigations and muscle biopsy were indicative of mitochondrial disease with multisystem involvement. Losses of consciousness disappeared after catheter ablation and treatment with levetiracetam.
  
  
  CONCLUSIONS
  Recurrent loss of consciousness in mitochondrial disease may not only be due to arrhythmias but also seizure activity, or autonomic neuropathy. Arrhythmias, seizures, and polyneuropathy may have a common underlying cause affecting various tissues.
authors: aKrankenanstalt Rudolfstiftung bClinical Institute of Neurology, Medical University Vienna cInstitute of Clinical Chemistry, Academic Hospital München-Schwabing, Germany dMedical Department, Krankenanstalt Rudolfstiftung, Vienna, Austria.
authors: Josef
authors: J
authors: Finsterer
authors: Romana
authors: R
authors: Höftberger
authors: Boris
authors: B
authors: Rolinski
authors: Claudia
authors: C
authors: Stöllberger
authors: Adelheid
authors: A
authors: Wöhrer
authors: Walter Benedikt
authors: WB
authors: Winkler
mesh_terms: D000368:Aged; D000927:Anticonvulsants / Q000627:therapeutic use; D001342:Autonomic Nervous System Diseases / Q000209:etiology; D001706:Biopsy; D017115:Catheter Ablation; D004562:Electrocardiography; D004830:Epilepsy, Tonic-Clonic / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D000077287:Levetiracetam; D008297:Male; D028361:Mitochondrial Diseases / Q000150:complications* / Q000175:diagnosis; D010889:Piracetam / Q000031:analogs & derivatives / Q000627:therapeutic use; D012008:Recurrence; D013575:Syncope / Q000209:etiology* / Q000517:prevention & control; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000077287:Levetiracetam; D010889:Piracetam