EPİLEPSİ AYIRICI TANISINDA ÜÇ OLGU İLE KARDİOVASKÜLER NEDENLER

Year 2009, Volume: 10 Issue: 2, 37 - 40, 01.08.2009

Nilgün Çöl Araz Kutluhan Yılmaz Akgün Ölmez Metin Kılınç

Abstract

Epilepsi çocukluk çağında %0.5-1 oranında görülen, tekrarlayıcı nöbetlerden oluşan klinik bir tablodur.Çocukluk çağında senkop görülme insidansı %15 olup, acil servise nöbetle başvuruların % 3-5'ine senkop nedenolmaktadır. Genel populasyonda senkopun epilepsiden daha yaygın görülmesine rağmen, bilinç kaybı ve nöbetlebaşvuran hastalarda genellikle akla ilk olarak epilepsi gelmektedir. Ayrıntılı tetkikler başta senkop ve diğerkardiyojenik kökenli hastalıklar olmak üzere diğer non-epileptik paroksizmal olayların da bilinç kaybının nedeniolduğunu gösterebilir.Bu yazıda çocuk acil servisi ve çocuk nörolojisi polikliniğine bilinç kaybıyla başvuran ve tetkiklerindekardiyovasküler nedenler saptanan üç olgu sunularak, epilepsi ayırıcı tanısında kardiyojenik kökenli senkoplarınmutlaka hatırlanması gerektiği vurgulandı

Keywords

Epilepsi, senkop, tilt testi, Wolf Parkinson White sendromu

Cardiovascular Etiology with Report of 3 Cases in Differential Diagnosis of Epilepsy

Abstract

Epilepsy is a disorder with an incidence of 0.5-1.0% in childhood and characterized by recurrent seizures. The incidence of syncope in childhood is 15% and it causes 3-5% of admissions to the emergency department. Although syncope is more frequent than epilepsy in general population, usually epilepsy is the first pre-diagnosis in patients with loss of consciousness and seizures. Detailed investigations may show other reasons like syncope and cardiologic diseases as the cause of loss of consciousness. In this paper,we present 3 patients admitted to the pediatric emergency department and pediatric neurology clinic with cardiovascular reasons in the etiology of loss of consciousness and pointed out that cardiac syncope should be remembered in the differential diagnosis of epilepsy.

Keywords

Epilepsy, syncope, tilt test, Wolf Parkinson White Syndrome

References

• 1. Petkar S, Cooper P, Fitzpatrick AP. How to avoid a misdiagnosis in patients presenting with transient loss of consciousness. Postgrad Med J 2006;82:630-41.
• 2. Ferrie CD. Preventing misdiagnosis of epilepsy. Arch Dis Child 2006;9:206-9.
• 3. Stroink H, Van Donselaar CA, Geerts AT, Peters AC, Brouwer OF, Arts WF. The accuracy of the diagnosis of paroxysmal events in children. Neurology 2003;60:979-82.
• 4. Eiris-Punal J, Rodriguez-Nunez A, FernandezMartinez N, Fuster M, Castro-Gago M, Martinon JM. Usefulness of the head-upright tilt test for distinguishing syncope and epilepsy in children. Epilepsia 2001;42:709-13.
• 5. Castro RRT, Nobrega ALC. Tilt table test in the differantial diagnosis of refractory “epilepsy”. Arq Bras Cardiol 2006;87:192-4.
• 6. Hindley D, Ali A, Robson C. Diagnoses made in a secondary care “fits, faints and funny turns” clinic. Arch Dis Child 2006;91:214-8.
• 7. The Task Force on Syncope, European Society of Cardiology. Guidelines on management (diagnosis and treatment) of syncope-update of 2004. Europace 2004;6:467-537.
• 8. Massin MM, Malekzadeh-Milani S, BenatarA. Cardiac syncope in pediatric patients. Clin Cardiol 2007;30:81- 5.
• 9. Tatlı B, Aydınlı N, Çalışkan M, Özmen M. Non epileptik paroksismal olaylar: olgu sunumları ile derleme. Türk PediatriArşivi 2004;39:58-64.
• 10. Zaidi A, Clough P, Copper P, Scheepers B, Fitzpatrick AP. Misdiagnosis of epilepsy: many seizure-like attacks have a cardiovascular cause. J Am Coll Cardiol 2000;36:181-4.
• 11. Dubin A. Disturbances of the rate and rhythm of the hearth. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson textbook of pediatrics. 18th ed. Philadelphia: Saunders Elsevier Press, 2007:1942-8.