IDF21-0446 Diabetes mellitus with micturition and defecation syncope: Etiology or chance association?

Abstract

Background: Syncope is a transient and abrupt loss of consciousness with complete return to pre-existing normal neurologic function. Defecation and micturition syncope are types of the situational syncope, which occur immediately after precipitating situations, such as defecation and urination respectively. Situational syncope are considered forms of neurally mediated syncope with reflex-mediated vasodilation and bradycardia, but possibly other mechanisms can also be involved. Micturition syncope is commoner than defecation syncope which is rarely described. Aim: We describe a case who presented with episodes of both micturition as well as defecation syncope. To the best of our knowledge, this is the first description of both types of syncope occurring in a single patient. Method: A 42 year old male, known case of diabetes mellitus since 10 years and on irregular blood sugar control presented to neurology department with complaints of episodic unconsciousness since last 5-6 years. History revealed total 5 episodes of syncope out of which 2 occurred while micturition and 3 while defecation. There were no associated signs suggesting seizure. There was no history of any drug intake except metformin and no history of chronic constipation. He denied history of angina, dyspnoea, palpitations and symptoms suggesting transient ischemic attacks. Results: Examination showed well-built individual with pulse 74 per minute (no arrhythmia), BP 134/76 mm Hg with no significant postural drop or tachycardia. ECG and ECHO were normal. 24 hour holter monitoring did not show any abnormality. Pelvic ultrasound was also normal. Discussion: Micturition syncope and defecation syncope are rare types of situational syncope. While all micturition syncope should be evaluated for bladder mass, defecation syncope should undergo testing for causes of chronic constipation if present. Autoimmune conditions like diabetes mellitus and hypothyroidism are also seen to be associated with these presentations. The exact mechanism of causation of these types of syncope in diabetes is yet unknown but future studies are needed to ascertain whether diabetes is an etiological factor in the causation of situational syncope.