Temporary Loss Of Consciousness Research Articles

Syncope in Migraine: A Genome-Wide Association Study Revealing Distinct Genetic Susceptibility Variants Across Subtypes.

Syncope is characterized by the temporary loss of consciousness and is commonly associated with migraine. However, the genetic factors that contribute to this association are not well understood. This study investigated the specific genetic loci that make patients with migraine more susceptible to syncope as well as the genetic factors contributing to syncope and migraine comorbidity in a Han Chinese population in Taiwan. A genome-wide association study was applied to 1,724 patients with migraine who visited a tertiary hospital in Taiwan. The patients were genotyped using the Affymetrix Axiom Genome-Wide TWB 2.0 array and categorized into the following subgroups based on migraine type: episodic migraine, chronic migraine, migraine with aura, and migraine without aura. Multivariate regression analyses were used to assess the relationships between specific single-nucleotide polymorphisms (SNPs) and the clinical characteristics in patients with syncope and migraine comorbidity. In patients with migraine, SNPs were observed to be associated with syncope. In particular, the rs797384 SNP located in the intron region of LOC102724945 was associated with syncope in all patients with migraine. Additionally, four SNPs associated with syncope susceptibility were detected in the nonmigraine control group, and these SNPs differed from those in the migraine group, suggesting distinct underlying mechanisms. Furthermore, the rs797384 variant in the intron region of LOC102724945 was associated with the score on the Beck Depression Inventory. The novel genetic loci identified in this study will improve our understanding of the genetic basis of syncope and migraine comorbidity.

Efficacy of lipid, NT-proBNP and D-dimer biomarkers in the differential diagnosis of patients presenting to the emergency department with syncope

Aims: Syncope is defined as a temporary loss of consciousness in any disorder characterized by a self-limited loss of consciousness, whatever the mechanism. It constitutes 3% of emergency service applications. NT-proBNP, D-dimer and lipids are important parameters in the diagnosis and differential diagnosis of patients with syncope. This study aims to determine the levels of these biomarkers during and after treatment in patients admitted to the emergency department(ED) due to syncope. Methods: Forty-nine patients admitted to the emergency department due to syncope were included in this study. Forty-nine age- and sex-matched individuals without a history of syncope were taken as the control group. Blood samples were taken from the patient group three times, at the time of admission to the emergency department, 24 hours after admission, and on the day they were discharged from the hospital, and only once from the control group. The patient and control groups were compared in terms of NT-proBNP, D-dimer and lipids. Results: The mean HDL level at discharge was 33.63±9.62 mg/dl, which was significantly lower than the mean HDL level in the control group (38.77±10.33 mg/dl) (t=2.14, p=0.012). Although the mean LDL levels at discharge (108.02±48.03 mg/dl) were higher than the control group (92.53±37.39 mg/dl), this increase was not statistically significant (t=1.78, p=0.078). However, the mean LDL levels during hospitalization and after 24 hours (126.08±51.88 mg/dl, 116.26±48.21 mg/dl, respectively) compared to the control group (92.53±7.39 mg/dl) were statistically significantly higher (t=3.67, p=0.001, t=2.73, p=0.008). NT proBNP and D-dimer median values at the time of admission to the emergency department (844.00 pg/ml, 616.50 mcg/L, respectively), after 24 hours (1985.00 pg/ml, 662.00 mcg/L, respectively) and at discharge (748.00 pg/ml, 702.50 mcg/L respectively) compared to the control group (85.00 pg/ml, 176.00 mcg/L, respectively), a statistically significant increase was detected (p=0.001). Conclusion: In the patients admitted to the ED with a diagnosis of syncope, early treatment can be achieved getting the differential diagnosis of syncope in a short time with NT-proBNP, D-dimer and lipid blood levels that can be worked easily. In addition, the need for serious interventional procedures and further investigations in the diagnostic process will be reduced.

Novel psychiatric disorders following mild traumatic brain injury: a retrospective multivariable analysis with screening recommendations.

Concussions are a form of mild traumatic brain injury (mTBI) that most commonly occur after blunt trauma to the head and may result in temporary loss of consciousness. These patients are typically comanaged by neurocritical care specialists, neurologists, and neurosurgeons depending on the severity of disease. The purpose of this study was twofold: 1) evaluate how patient demographic characteristics impact the development of novel psychiatric disorders (NPDs) after mTBI; and 2) develop screening recommendations to identify patients with NPDs. The authors used data from the 2010-2019 National Readmissions Database of the Healthcare Cost and Utilization Project. Patients who were readmitted for mTBI within a year of their first admission between 2010 and 2019 were identified (n = 206,070). The association between patient demographic characteristics and the emergence of NPDs after mTBI was examined using multivariable binomial regression analysis. Density plots were used to examine diagnostic patterns for NPDs. The mean ± SD age of all patients was 50.9 ± 26.2 years, and 43.9% of patients were female. Overall, an additional 818 (0.40%) patients were reported to have novel suicidal ideation (SI), 3866 (1.9%) novel depression, 3449 (1.7%) novel anxiety, and 88 (0.043%) novel homicidal ideation (HI) after mTBI. Younger age (OR 0.9775, 95% CI 0.9705-0.9848, p < 0.0001) and reduced Charlson Comorbidity Index (CCI) score (OR 0.9155, 95% CI 0.8539-0.9774, p = 0.010) may predict novel SI, and female sex (OR 0.7464, 95% CI 0.6026-0.9214, p = 0.0069) may be inversely related to novel SI after mTBI. Also, multivariable analysis found that female sex (OR 1.1774, 95% CI 1.0654-1.3016, p = 0.0014) and Medicare/Medicaid insurance type (OR 0.9381, 95% CI 0.8983-0.9797, p = 0.0039) may predict novel anxiety after mTBI. Similarly, younger age (OR 0.9956, 95% CI 0.9923-0.9989, p = 0.0096), higher CCI score (OR 1.0363, 95% CI 1.0099-1.0629, p = 0.0062), and Medicare/Medicaid insurance type (OR 0.9386, 95% CI 0.8998-0.9789, p = 0.0032) may predict novel depression. Lastly, female sex (OR 0.3271, 95% CI 0.1467-0.6567, p = 0.0031) and increased median income (OR 0.8829, 95% CI 0.7930-0.9944, p = 0.049) were inversely proportional to novel HI after mTBI. The median time to diagnosis of NPD was 69.5 days for depression, 66.5 days for anxiety, 70.0 days for SI, and 66.5 days for HI. Numerous patient demographic factors are significant predictors of the development of NPDs after mTBI and concussion. Screening for NPDs within 3 weeks and 3 months after mTBI may identify most patients at risk for developing novel postconcussive psychiatric conditions, including anxiety, depression, HI, and SI. Further studies are warranted to understand how patient demographic characteristics should dictate medical management and screening after mTBI and concussion.

Transient loss of consciousness: Neurally-mediated syncope, psychogenic syncope or epilepsy? A cross-sectional study

Aim: This study aimed to define important clinical and laboratory features that may be useful in the differential diagnosis of pediatric patients who presented with temporary loss of consciousness and in whom cardiac causes had been excluded, especially in the differentiation of convulsive syncope and epileptic seizure. Methods: The records of patients presenting with temporary loss of consciousness and in whom cardiac causes had been excluded, were retrospectively evaluated. All patients were grouped according to their diagnosis and the data were evaluated comparatively. Results: Six-hundred-and-twelve patient files were evaluated, and 350 patient files were included in the study. 68.6% of the patients were diagnosed with vasovagal syncope, 13.1% were diagnosed with psychogenic pseudosyncope and 18.2% of the patients were diagnosed with epilepsy. In addition, compared to other subgroups, the patients in the epilepsy group were younger (p

Rare dizziness, syncope, loss of consciousness, seizure, and risk of falling after vaccination

&lt;abstract&gt; &lt;p&gt;Some individuals experience dizziness, syncope (temporary loss of consciousness caused by a fall in blood pressure), seizure, and similar rare adverse events after vaccination. Sudden impacts to alertness, consciousness, ability to talk, vision, or balance may pose rare risks for some vaccinees for a few days post vaccination. Herein, the Vaccine Adverse Event Reporting System (VAERS) database is examined for relevant adverse events. These adverse events exhibit a consistent pattern of onset soon after vaccination consistent with other reported reactogenicity adverse events. The onset of these adverse events soon after vaccination provides supportive evidence to reject the hypothesis that the majority of these adverse events represent background occurrences unrelated to vaccination. The immediate onset timing of these adverse events represent a pattern that warrants further study. The observed onset pattern for multiple unrelated vaccines are consistent with the possible etiology of innate immune responses to vaccination as causative for these observed adverse events. Cautionary avoidance of some activities immediately following vaccination may reduce accidental injuries.&lt;/p&gt; &lt;/abstract&gt;

Voriconazole Associated Hypertension: A Case Report

Objective: The study report a case of a young female with candida tropicalis and candida krusei infection who developed severe hypertension after she had repeated received voriconazole for few days.&#x0D; Case Presentation: A 23-year-old female was admitted to hospital because of recurrent urinary tract infection. She underwent horseshoe nephrectomy, extracorporeal lithotripsy treatment and double J-tube placement in the past 5 years. After multiple surgeries, she developed recurring fungal urinary tract infections and underwent anti-infective treatment. Twenty days ago, the patient developed chills, fever, dizziness, fatigue, urinary tract irritation signs and bilateral low back pain. Urine culture suggests Candida croco (resistant to fluconazole). After taking antifungal therapy with voriconazole 300 mg q12h, the patient experienced an unexplained increased blood pressure and transient loss of consciousness.&#x0D; The patient began to experience an increase in blood pressure (140-160/90-100 mmHg) on the second day of voriconazole treatment. After 5 days of taking voriconazole, the patient developed fatigue, dizziness and blurred vision with persistent hypertension (150/100 mmHg), and temporary loss of consciousness and syncope on day8, when blood pressure was measured at 175/95 mmHg.&#x0D; Conclusion: This case illustrates that acute blood pressure elevation may manifest in patients taking normal doses of voriconazole, which deserves the attention of clinicians.

Assessment of Canadian Syncope Risk Score in the prediction of outcomes of patients with syncope at the Emergency Department of Suez Canal University: STROBE compliant.

Syncope is a temporary loss of consciousness usually related to insufficient blood flow to the brain. It's also called fainting or "passing out.” Syncope is responsible for 3% to 5% of emergency department visits, with a hospitalization rate in about 40% of cases, with an average stay of 5.5 days. The Canadian Syncope Risk Score showed good discrimination and calibration for 30-day risk of serious adverse events after disposition from the emergency department.The aim was to assess Canadian Syncope Risk Score in predicting outcomes and mortality at the emergency department of Suez Canal University Hospitals.A prospective observational cohort study was carried out in emergency department in Suez Canal University Hospital. After approval by the Ethical and Research Committee of Faculty of Medicine, Suez Canal University, 60 patients with syncope attending to emergency department were included to this study. All included participants were assessed by history taking and they also assessed by the Canadian Syncope Risk Score.The Canadian Syncope Risk Score's mean of the study group was 4.9 and the range of the scores was from −2 to 11. The mean of the percentage of risk of serious events at 30 days in the study group was 29.17% and it ranged from 0.7% to 83.6%.There was a statistically significant difference between means Canadian Syncope Risk Score's score regarding complication occurrence. Cases which showed complications had a mean score of 7.33 compared to a mean score of 1.25 in case of no complication occurrence P-value <.001. At a cut-off point of more than 3 for the Canadian Syncope Risk Score's, sensitivity of that score in complication's occurrence prediction was 100% and the specificity was 87.5% P-value <.001.The Canadian Syncope Risk Score's is strong predictor for risk of serious adverse events and a good indicator for admission, with 100% sensitivity and 87.5% specificity at cut off point more than 3.

Medical and social features of providing medical care for population with mild traumatic brain injury due to blast wave action

Due to the war in Ukraine, the number of servicemen and civilians with a mild form of traumatic brain injury (TBI) caused by the blast has increased. Pathogenesis, clinic, treatment, rehabilitation of patients with TBI differ from these parameters in patients with trauma in peacetime (mainly road and sports). The aim of this study was to establish the relationship between the pathogenesis, clinic and features of the treatment of trauma caused by the blast wave, with the organization of medical care for this category of patients. The article also highlights some issues of quality of life of patients and the social significance of the consequences of the disease in light of the prevalence of pathology. The methods of system analysis and bibliosemantic method were used in the research. Statistical data and scientific publications on the incidence and consequences of TBI, its long-term consequences, features of treatment and rehabilitation have been studied. The main consequence of the explosive trauma is concussion, the reverse state, the pathogenesis of which is based on temporary functional disorders. Such concussions are accompanied by cerebral symptoms (without further focal neurological symptoms), autonomic vascular reactions, temporary loss of consciousness and memory. General practitioners, physical therapists, neurologists, neurosurgeons, psychia­trists, psychologists, traumatologists, resuscitators, otolaryngologists, and rehabilitation specia­lists should be involved in providing medical care to the victims. Medical facilities providing medical care to victims should be provided with drugs for the treatment of headache (tension pain and migraine pain), dizziness, vertigo, loss of consciousness, tinnitus, sleep disorders, cognitive disorders. Given the importance of the regime for the successful treatment and rehabilitation of patients, physicians should have sufficient time to consult patients, which should be taken into account when planning his workload. Keywords: traumatic brain injury, medical and social consequences, the quality of life of patients.

Recurrent Hematochezia with Abnormal Mesenteric Angiography

Question: A 17-year-old young man presented with several episodes of massive hematochezia, accompanied by temporary loss of consciousness. The patient continued to have intermittent hematochezia over the last 3 years, twice requiring hospitalization and blood transfusion. There is no symptom of abdominal pain, nausea, vomiting, or hematemesis before the onset of hematochezia, nor any clinical manifestation during the intervals of the attacks. He denied alcohol consumption or drug intake history.

Temporary loss of consciousness during cetuximab treatment of a patient with metastatic colon cancer: a case report

BackgroundAnti-epidermal growth factor receptor (EGFR) antibody is widely used for the treatment of patients with metastatic colorectal cancer. Hypomagnesemia is a comparatively frequent adverse event of this drug, which is likely overlooked because it occurs later in treatment without symptoms. Furthermore, hypomagnesemia and hypomagnesemia-induced corrected QT (QTc) prolongation may lead to loss of consciousness (LOC), the onset of which is not generally considered associated with the treatment of anti-EGFR antibody because of its rare occurrence. Here, we present a colorectal cancer patient treated with anti-EGFR antibody, who suffered LOC during treatment while severe hypomagnesemia or QTc prolongation was not observed.Case presentationA 69-year-old man with metastatic colon cancer was treated with cetuximab (anti-EGFR antibody) plus irinotecan as third-line chemotherapy. His serum magnesium level gradually decreased, and grade 2 hypomagnesemia (a serum magnesium level of 0.9 mg/dL) was observed at the 12th administration of cetuximab. In light of this development, intravenous supplementation of 20 mEq magnesium sulfate began with careful blood monitoring despite the lack of clinical symptoms. Electrocardiogram (ECG) showed prolonged QT or corrected QT (QTc) intervals (grade 1). His serum magnesium level remained at 0.9 mg/dL, and no hypomagnesemia symptoms were observed by the 17th administration of cetuximab. After the treatment, however, he suddenly lost consciousness without symptoms related to infusion or allergic reactions. Circulatory collapse following dermatological reactions and respiratory events were not evident. Intravenous supplementation of magnesium sulfate was administered again. He awakened 2 min after the onset of temporary LOC without any other symptoms related to hypomagnesemia, such as lethargy, tremor, tetany, and seizures. No other etiology outside of the low level of serum magnesium was confirmed in further examinations. Cetuximab was discontinued, and his serum magnesium level returned to a level within the normal range after 6 weeks. Because of tumor progression, regorafenib and TAS-102 (trifluridine tipiracil hydrochloride) were introduced sequentially for 6 months. Five months after the final treatment of TAS-102, he died of his primary disease, which reflected a survival period of 4 years and 6 months since the beginning of treatment.ConclusionsThis case report reminds clinicians that LOC can be induced without severe hypomagnesemia or QTc prolongation, during anti-EGFR antibody treatment for metastatic colorectal cancer even while under carefully monitored magnesium supplementation.

Does A Therapy for Reflex Vasovagal Syncope Really Exist?

Syncope is a temporary loss of consciousness due to transient global cerebral hypoperfusion. Reflex syncope is the most frequent, representing 21% of all types of syncopal events, and includes: (a) the vasovagal syncope (classical type); (b) the situational syncope; (c) the carotid sinus syncope and (d) non-classical forms. An accurate anamnesis and physical examination are fundamental for the diagnosis. Although limited evidence is available regarding the efficacy of some treatments, a number of these can be successfully used in the clinical practice. It is, however, important to personalize the therapeutic approach in order to achieve an efficient reduction or suppression of syncopal episodes. Patients should be reassured about the benignity of these events and the possibility of reducing their frequency over time. They should be also educated on how to recognize and abort incoming syncopal episodes. Patients may be advised to increase their introit in water and salt, as well as to reduce vasoactive medications, if no contraindications exist. Orthostatic training may be beneficial but only in very motivated young patients capable of strictly adhering to the exercise plan. So far, any proposed pharmacological treatment has demonstrated very limited efficacy and, therefore, it should be tried in case of failure of non-pharmacological approaches. Pacemaker implantation is clearly indicated in patients with documented cardioinhibitory syncope in the absence of a vasodepressor component, which can compromise their quality of life. Despite the American and European guidelines for the treatment of syncope are similar, still some differences can be denoted. Aim of this study is to evaluate the management of patients with recurrent syncopal episodes focusing on pharmacological and non-pharmacological approaches.

Current Concepts of Pathophysiology of Vasovagal Syncope and its Evaluation and Management: A Review

Vasovagal syncope (VVS) with a sudden, temporary loss of consciousness (LoC) is a common phenomenon in the young and the elderly. Though generally described as innocuous, it may lead to serious consequences in special category of people (pilots), or in the elderly in whom LoC may lead to a fall and serious injury. The topic has been copiously researched upon and discussed in medical literature over the last few decades, but the exact mechanisms which lead to the disability have yet to be fully agreed upon. Changes in cardiovascular baroreceptor sensitivity, aberrations in the complex interaction amongst the nucleus of the tractus solitarius and the nuclei around it, inability of the peripheral circulation to respond to autonomic vasoconstrictors, or excess production of vasodilators such as nitric oxide produced locally have been considered in its pathophysiology. Various extraneous situations like dehydration, exposure to heat stress, medications, psychological factors may adversely stress regulatory physiological responses and promote occasional episodes of VVS. More complex dysautonomia could be a reason for the recurrent VVS. Differences between brain structure of VVS sufferers and normal subjects have been proposed. Head-up tilt table (HUT) test is the most widely applied investigation for evaluating VVS episodes. Lower body negative pressure (LBNP) has also been used. Enhancement of the orthostatic stress may be done by simultaneous use of both, or with peripheral vasodilators. As to whether such an enhancement is necessary is debatable. Management with increased salt and fluid intake, corticosteroids, beta adrenergic receptor blockers, alpha adrenergic receptor stimulants, selective serotonin reuptake inhibitors, and nitric oxide synthase inhibitors have been tried with variable success.

Management of Traumatic Brain Injury: A review Update

Traumatic Brain Injury leads to serious consequences. Approximately half of all deaths is related to traumatic injury and the main cause of head trauma. Extradural haematomas (EDH) develops in all major head injuries. A head injury patient who is only temporary loss of consciousness and is left asleep may sometimes be found dead in the bed next morning due to extradural haematoma. Extradural haematoma which lies in between the inner surface of skull and stripes of dural membrane, are nearly always caused by, and located near a skull fracture. The collection takes several forms in terms of size, location, speed of development and effects they exert on patient. Immediate management is necessary to decrease the bad consequences. In this review the management of traumatic brain injury is highlighted.J Shaheed Suhrawardy Med Coll, 2014; 6(2):87-89

Executive summary of Concussion guidelines step 1: systematic review of prevalent indicators.

This is a summary of the first in a series of reports that will be generated by this working group that are intended to build an evidence base for concussion. This first report, Step 1, is a systematic review of prevalent indicators of concussion that used the highest-quality published literature and a rigorous process of publication selection, quality assessment, and data abstraction and synthesis. It is the foundation on which we will base future work to derive a classification system for concussion and guidelines for diagnosis, prognosis, and treatment. METHODS Key questions were identified and electronic literature searches conducted from 1980 to September 2012. Publications meeting the prespecified inclusion criteria were assessed for potential for bias and confound and were rated as “low, medium, or high” potential for bias and confound. Data were abstracted from those publications meeting a minimum threshold of “medium.” RESULTS Of 5592 abstracts of potentially relevant studies, 1362 full-text publications were acquired and read for eligibility. Two hundred thirty-one met the prespecified criteria, and of those, 62 publications were rated as medium potential for bias and confound. Of the 62 publications, 26 had inclusive case definitions, reported data at fixed time points relevant to 1 or more of the key questions, and are included in the analysis. Eleven independent samples from 8 publications contributed data for the final analysis. Indicators of concussion, observed in alert (alert: Glasgow Coma Scale Score, 13 to 15) individuals after a force to the head, are the following: Observed and documented disorientation or confusion (disorientation or confusion: loss of one's sense of direction, position, or relationship with one's surroundings) immediately after the event Impaired balance (balance: a state of body equilibrium) within 1 day after injury, Slower reaction time (reaction time: the interval of time between application of a stimulus and detection of a response) within 2 days after injury, and Impaired verbal learning and memory (verbal learning and memory: the acquisition, retention, and retrieval of verbal material; memory of words and other abstractions involving language) within 2 days after injury. DISCUSSION A concussion is a change in brain function after a force to the head that may be accompanied by temporary loss of consciousness but is identified in awake individuals with the use of measures of neurologic and cognitive dysfunction. At this time, there are no known physiologic measures to identify this change in function. Consequently, observed physiologic phenomena (signs), subjective reports (symptoms), and objective measures of neurologic and cognitive dysfunction (deficits) that may be indicators of the underlying change in brain function are used to identify individuals with a high likelihood of having a concussion. The task of this project was to identify which signs, symptoms, and neurologic and cognitive deficits have the highest and most consistent prevalence in samples of individuals sustaining a potentially concussive event and to assess how they associate. From the available evidence, increased reaction time, impaired verbal learning and memory, impaired balance, and disorientation or confusion were found to be significantly prevalent in early samples of exposed individuals. There is insufficient evidence to assess the relationships among these measures. FUTURE RESEARCH Many of the publications not included in this review were well done and adequately addressed the investigators' prespecified research questions. They were not, however, designed to generate supporting evidence for the prevalence of indicators of concussion. Most of the studies were excluded primarily because of a lack of comparison groups, mixed patient populations, time from injury not specified, measures not validated, and data reported as composite scores. Of the included publications, many could not be used in the primary analysis because of high potential for bias and confound, exclusive case definitions, or lack of relevant and/or fixed time points for measures. Of those used in the analysis, key limitations included the lack of simple correlational analyses and the use of average scores to compare differences between groups. What is needed next is a “decomplicated” body of information that provides simple counts of signs, symptoms, neurologic and cognitive deficits; and valid and reliable outcome measures; and that associates those measures across time in the form of proportions. The forthcoming report from this working group, “Concussion Guidelines Step 2: Diagnostic Criteria,” will serve to fill this information gap and will take the next step in developing guidelines for the diagnosis, prognosis, and treatment of concussion. Disclosure Dr Jagoda is a consultant for Banyan Biomarkers. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. There are no conflicts of interest. The Brain Trauma Foundation Concussion Guidelines project is supported by the US Army Contracting Command, Aberdeen Proving Ground, Natick Contracting Division, under contract No. W911QY-11-C-0074. The Brain Trauma Foundation provided funding for 2 meetings of the Panel of Technical Experts.

Vasovagal syncope: highlighting an understated event in aesthetic medicine

Vasovagal syncope, also known as cardioneurogenic syncope, is a condition in which a temporary loss of consciousness occurs owing to a neurological reflex, which leads to sudden dilation of the blood vessels in the legs and/or a very slow heart rate (bradycardia) ( Fogoros, 2012 ). Although many clinicians refer to this event as a ‘simple faint’, the author maintains that vasovagal syncope is an understated medical condition that arises frequently in the practice of aesthetic medicine. In this article, the author will give an overview of vasovagal syncope in the context of medical aesthetics, examine the diagnostic process and discuss why there is a need to consider differential diagnoses. Further to this, the condition's pathogenesis, symptom management and available treatment options will be explored, and the author will outline how aesthetic practitioners and patients can implement simple strategies to avoid the occurrence of this often extremely distressing event.

Physical Training as Non-Pharmacological Treatment of Neurocardiogenic Syncope

BackgroundCharacterized as a sudden and temporary loss of consciousness and postural tone, with quick and spontaneous recovery, syncope is caused by an acute reduction of systemic arterial pressure and, therefore, of cerebral blood flow. Unsatisfactory results with the use of drugs allowed the nonpharmacological treatment of neurocardiogenic syncope was contemplated as the first therapeutic option. ObjectivesTo compare, in patients with neurocardiogenic syncope, the impact of a moderate intensity aerobic physical training (AFT) and a control intervention on the positivity of head-up tilting test (HUT) and orthostatic tolerance time. MethodsWere studied 21 patients with a history of recurrent neurocardiogenic syncope and HUT. The patients were randomized into: trained group (TG), n = 11, and control group (CG), n = 10. The TG was submitted to 12 weeks of AFT supervised, in cycle ergometer, and the CG to a control procedure that consisted in 15 minutes of stretching and 15 minutes of light walk. ResultsThe TG had a positive effect to physical training, with a significant increase in peak oxygen consumption. The CG did not show any statistically significant change before and after the intervention. After the intervention period, 72.7% of the TG sample had negative results to the HUT, not having syncope in the revaluation. ConclusionThe program of supervised aerobic physical training for 12 weeks was able to reduce the number of positive HUT, as it was able to increase tolerance time in orthostatic position during the HUT after the intervention period.

Spontaneous rupture of a dissecting aneurysm in the superior rectal artery of a patient with neurofibromatosis type 1: a case report

IntroductionNeurofibromatosis type 1 is an autosomal dominant disease primarily characterized by cutaneous café au lait spots, benign cutaneous neurofibromas, tumors of the central and peripheral nervous system, multiple skeletal abnormalities, and vascular abnormalities.Case presentationHere we describe the case of a 39-year-old Japanese man with neurofibromatosis type 1 complicated by the rupture of a dissecting aneurysm in his superior rectal artery. Our patient presented with temporary loss of consciousness and acute abdominal pain. Hemorrhagic shock and anemia were diagnosed based on a physical examination and laboratory investigations, and rapid infusion of Ringer’s lactate solution was initiated. Contrast-enhanced abdominal computed tomography revealed hemorrhagic ascites with effusion of radiopaque dye into his pelvic cavity. A ruptured aneurysm was suspected in his superior rectal artery and selective angiography of the inferior mesenteric artery confirmed this diagnosis. Transcatheter arterial embolization was successfully performed and our patient was discharged 15 days after admission, with good recovery of his hemoglobin level, and no further hemorrhage or abdominal pain.ConclusionThis case of spontaneous rupture of a dissecting aneurysm in the peripheral blood supply strongly suggests the involvement of multiple blood vessel abnormalities in neurofibromatosis type 1. Patients with neurofibromatosis type 1 should undergo regular review given their overall health and the risk of fatality in vasculopathy associated with this disease.

General Anesthesia

Appropriate balance between excitatory and inhibitory neural activity patterns is of utmost importance in the maintenance of neuronal homeostasis. General anesthetic-induced pharmacological interference with this equilibrium results not only in a temporary loss of consciousness but can also initiate long-term changes in brain function. Although these alterations were initially considered deleterious, recent observations suggest that at least under some specific conditions, they may eventually improve neural function. The goal of this review is to provide insights into the mechanisms underlying these dual effects. Basic science issues on the important role of critical periods during neural circuitry assembly will be discussed to better understand how even brief exposures to general anesthetics could initiate context-dependent lasting changes in neuronal structure and function. Recent series of observations suggesting a developmental stage-dependent impact of these drugs on synaptogenesis will then be summarized together with currently known molecular mechanisms underlying these effects. Particular emphasis will be placed on how anesthetic drugs modulate neural plasticity in the adult brain and how this may improve neural function under some pathological states. The ensemble of these new observations strongly suggests that general anesthetics should not merely be considered toxic drugs but rather acknowledged as robust, context-dependent modulators of neural plasticity.

Pyloric Stenosis as Cause of a Venous Hypertensive Syndrome Mimicing True Shaken Baby Syndrome

A syndrome of bleeding in the brain with retinopathy, but no external evidence of trauma, is known in infants. There is an association with excessive crying and feeding difficulties in this condition. This has led to the hypothesis that the injuries arise during violent shaking by an angry carer, causing the brain to rotate relative to the skull, (Shaken Baby Syndrome, SBS). An alternative hypothesis, described here, (Dysphagic Infant Death Syndrome DIDS), is that injuries similar to those in SBS can result from venous hypertension during excessive coughing or vomiting. Such injuries occur “naturally” during paroxysms of coughing in Whooping Cough. High intra-abdominal pressure drives abdominal venous blood up into the head, rupturing intracranial veins and capillaries. This results in subdural haemorrhages, petechiae in skin and Valsalva Retinopathy in the eyes. This article considers when the excessive intra-abdominal pressures are caused by violent vomiting and retching in pyloric stenosis. Some DIDS additional features, not occurring in SBS, may give warning of impending intracranial catastrophe. Infant skull suture growth rate depends on local stretch induced in the underlying Dura Mater. This will be increased during venous hypertension, accelerating head growth rate analogous to the hydrocephalous mechanism. The prolonged inconsolable crying would be explained by Mallory-Weiss tears at the oesophageal-stomach junction during repeated vomiting. Edema resulting from local leakage from over-distended cerebral veins and capillaries may temporarily disable axon transmission, causing temporary loss of consciousness. Transient “spiking” fevers may seen in this condition if the temperature limiter center in the hypothalamus is temporarily disabled by such flooding. (Brainstem tissue is drained by the vertebral vein system whose tortuous nature smoothes out pressure spikes. This provides some protection of breathing and cardiac mechanisms which may remain normal.) It is concluded that, unlike SBS, preventative measures should be possible for DIDS.

Influence of paroxetine and cognitive/behavioral strategies in neurocardiogenic syncope and depression: a case report

OBJECTIVE: Neurocardiogenic syncope (NCS) is a condition where the patient has a temporary loss of consciousness or feelings of weakness and fatigue. There are triggers such as prolonged sitting or standing, pain, and heavy exercise, but often episodes are random. Treatments are limited and the use of specific serotonin reuptake inhibitors (SSRI) have had mixed results, but a limited number of studies have suggested that paroxetine may be effective in improving the symptoms of NCS. METHODS: This is a single case report of a 20-year old female who was diagnosed with NCS by a tilt test and treated conservatively with increased fluid and salt intake, and counter-pressure maneuvers. She was given one dose of sertraline, but immediately experienced disturbing visual images. She presented at the Depression Center with moderate depressive symptoms and was started on paroxetine and given cognitive/behavioral strategies to manage the NCS. RESULTS: Since the patient had a negative experience with a prior SSRI, she was started on a low dose of paroxetine and omega-3 fatty acids. She also was given a detailed explanation of NCS and a number of cognitive/behavioral strategies such as deep breathing, progressive relaxation, imagery, and sleep. CONCLUSION: After 2-weeks of the multi-faceted treatment approach, she had a significant decrease in her depressive symptoms. After 6-months, the patient had no episodes of syncope and no depressive symptoms. She was able to stand for long periods and exercise without feelings of weakness and fatigue. A multimodal approach may offer the best treatment strategy to achieve full remission in patients with NCS.