Micturition syncope

Abstract

The case history is presented of a 37-year-old pilot with micturition syncope. Three spontaneous nocturnal attacks were observed clinically and with EEG and ECG recording. These recordings started at the moment the patient went to bed. In this way the EEG and ECG on awaking during the night, rising from the bed and voiding while in the upright position were studied. Since fainting always occured some 30 sec after the patient had finished voiding and since no obstruction in the urogenital tract and bladder was found, and the patient denied straining on micturition, a Valsalva effect cannot be regarded as an important aetiological factor. The syndrome is considered to be a vaso-vagal or vasodepressor reaction upon assuming the upright position under special circumstances, in which a low heart rate combined with lowered peripheral vascular resistance is presumably the most important factor. From the EEG and ECG records it is clear that the attacks are not of epileptic origin and that they cannot be explained by slowing of the heart rate alone. EEG recording during an attack is considered to be essential for differentiating between this syndrome and epilepsy because they may resemble each other clinically and because the resting EEG nearly always shows a normal pattern. The syndrome was not considered as a contraindication for licensing the pilot.