Abstract
Amaç: Çocuklarda en sık nörokardiyojenik senkop görülmekle birlikte, altta yatan pek çok kardiyak ve nörolojik hastalık senkopa yol açabilir. Buna karşın nedene yönelik yapılan incelemelerin tanısal değeri oldukça düşüktür. Bu çalışmada, senkop nedeniyle başvuran hastaların klinik özellikleri, etiyolojisi ve yapılan incelemelerin tanısal değerinin belirlenmesi amaçlandı.Gereç ve Yöntemler: Temmuz 2011 ile Aralık 2013 tarihleri arasında çocuk nöroloji bölümüne senkop nedeniyle yönlendirilen 169 (%70.1) kız, 72 erkek (%29.9) toplam 241 hastanın dosyası retrospektif olarak incelendi. Senkop etiyolojisi ve tanı amaçlı yapılan testlerin tanıya ulaşmadaki değeri belirlendi.Bulgular: Olguların 146’sında (%60.6) nörokardiyojenik senkop, 30’unda (%12.4) postural ortostatik taşikardi sendromu (POTS), 22’sinde (%9.1) epilepsi, 6’sında (%2.5) kardiyak senkop, 23’ünde (%9.5) psikojenik psödosenkop, 4’ünde (%1.7) refleks senkop, 1’inde (%0.4) hidrosefali saptanırken, 9 (%3.7) hastada etiyoloji belirlenemedi. Yüz elli yedi (%65.1) olguya elektroensefalografi incelemesi yapıldı ve bunların 25’inde (%15.8) epileptik aktivite görüldü. Nörogörüntüleme yapılan 95 (%39.4) hastanın 1’inde (%1.1) mezial temporal skleroz, 1’inde (%1.1) akuaduktus Sylvii stenozu görülürken, 12 (%13.0) hastada rastlantısal nonspesifik beyaz cevher lezyonları izlendi. Olguların tamamına yapılan elektrokardiyografinin, 3’ünde (%1.3) tam atrio-ventriküler blok, 1’inde (%0.4) 2. derece atrio-ventriküler blok (Mobitz Tip II), 1 (%0.4) tanesinde ise kısa PR aralığı ve delta dalgası saptandı. Ekokardiyografik incelemede, olguların 11’inde (%4.6) mitral kapak prolapsusu, 3’ünde (%1.7) mitral yetersizlik saptanırken, 1 (%0.4) hastada ağır valvüler aort stenozu görüldü. Tilt testi yapılan 93 (%38.6) hastanın 34’ünde (%36.5) POTS saptanırken 14’ünde (%15.0) vazodepresör yanıt gözlendi. Holter testi yapılan 21 (%8.7) hastanın sadece 1’inde (%4.7) anormal kayıt bulundu. Hiçbir hastada senkop nedeni olarak anemi, elektrolit imbalansı ya da hipoglisemi saptanmadı.Sonuç: Pek çok nörolojik ve kardiyak hastalık senkop nedeni olabilir. Ayrıntılı öykü, fizik muayene ve EKG ile hastaların çoğuna tanı konulabilir. Elektroensefalografi, nörogörüntüleme, ekokardiyografi, tilt testi, holter testi ve rutin kan testlerinin tanıya katkısı oldukça sınırlıdır.
Keywords
References
- Feit LR. Syncope in the pediatric patient: Diagnosis, pathophysio- logy, and treatment. Adv Pediatr 1996;43:469-94.
- Fischer JWJ, Cho CS. Pediatric syncope: Cases from the emergency department. Emerg Med Clin North Am 2010;28: 501-16.
- Anderson JB, Czosek RJ, Cnota J, Meganathan K, Knilans TK, Heaton PC. Pediatric syncope: National hospital ambulatory medical care survey results. J Emerg Med 2012;43:575-83.
- Driscoll DJ, Jacobsen SJ, Porter CJ, Wollan PC. Syncope in children and adolescents. J Am Coll Cardiol 1997;29:1039-45.
- Ganzeboom KS, Colman N, Reitsma JB, Shen WK, Wieling W. Prevalence and triggers of syncope in medical students. Am J Cardiol 2003;91:1006–8.
- Kapoor WN. Syncope. N Engl J Med 2000;343:1856–62.
- Massin MM, Bourguignont A, Coremans C, Comté L, Lepage P, Gérard P. Syncope in pediatric patients presenting to an emer- gency department. J Pediatr 2004;145:223–8.
- Brignole M, Alboni P, Benditt DG, Bergfeldt L, Blanc JJ, Thomsen PEB, et al. Guidelines on management (diagnosis and treatment) of syncope-update 2004. Executive Summary. Eur Heart J 2004;25:2054–72.
- Hegazy RA, Lotfy WN. The value of Holter monitoring in the assessment of pediatric patients. Indian Pacing Electrophysiol J 2007;7:204–14.
- Prodinger RJ, Reisdorff EJ. Syncope in children. Emerg Med Clin North Am 1998;16:617–26.
- Landau WM, Nelson DA. Clinical neuromythology XV. Feinting science: Neurocardiogenic syncope and collateral vasovagal confusion. Neurology 1996;46:609–18.
- Syncope or seizure? The diagnostic value of synchronous tilt testing and video-EEG monitoring in children with transient loss of consciousness. Epilepsy Behav 2012;24:93–6.
Etiology of Syncope in Children and the Value of Neurologic and Cardiologic Investigations in Diagnosis
Abstract
Objective: Although neurocardiogenic syncope is the most common type of syncope in children, a wide variety of neurologic and cardiologic disorders may present with syncope. However, the diagnostic yield for most tests commonly used in the evaluation of children with syncope is low. We aimed to document the clinical characteristics, etiology, and the value of neurologic and cardiologic investigations in the diagnosis of syncope in children.Material and Methods: Hospital charts of 241 children (169 female and 72 male) who were referred to the pediatric neurology department due to syncope between July 2011 and December 2013 were retrospectively reviewed. Outcome variables were etiology and yield of diagnostic tests performed.Results: The etiology was neurocardiogenic syncope in 146 (60.6%), postural ortostatic tachycardia syndrome (POTS) in 30 (12.4%), epilepsy in 22 (9.1%), cardiac causes in 6 (2.5%), psychogenic pseudosyncope in 23 (9.5%), reflex syncope in 4 (1.7%), unspecified syncope in 9 (3.7%) patients and hydrocephalus in 1 (0.4%) patient. Electroencephalography was performed in 157 (65.1%) patients and revealed epileptic discharges in 25 (15.8%) of them. Neuroimaging studies were performed in 95 (39.4%) patients and revealed incidental white-matter lesions in 12 (13%) patients and mesial temporal sclerosis and aqueductus Sylvii stenosis in 1 patient (%1.1) each. Electrocardiography was performed in all patients and revealed complete atrioventricular block in 3 (1.3%) patients and 2nd degree atrio-ventricular block (Mobitz type II) and short PR interval with a delta wave in 1 (0.4%) patient each. Echocardiography was performed in all patients and revealed mitral valve prolapsus in 11 (4.6%), mitral regurgitation in 3 (1.2%) patients and severe aortic stenosis in 1 patient (0.4%). Tilt testing was performed in 93 (38.6%) patients and revealed POTS in 34 (36.5%) and vasodepressor response in 14 (15.0%) patients. The Holter test was performed in 21 (8.7%) patients and was abnormal in 1 (4.7%) of them. Anemia, hypoglycemia or electrolyte imbalance was not found to be the cause of syncope in any of the patients.Conclusion: A wide variety of neurologic or cardiac disorders can present with syncope in children. A focused history and a thorough clinical examination along with electrocardiography can reveal the cause of syncope in the majority of cases. The yield of electroencephalography, neuroimaging, echocardiography, tilt test, Holter test, and routine blood tests is very low
Keywords
References
- Feit LR. Syncope in the pediatric patient: Diagnosis, pathophysio- logy, and treatment. Adv Pediatr 1996;43:469-94.
- Fischer JWJ, Cho CS. Pediatric syncope: Cases from the emergency department. Emerg Med Clin North Am 2010;28: 501-16.
- Anderson JB, Czosek RJ, Cnota J, Meganathan K, Knilans TK, Heaton PC. Pediatric syncope: National hospital ambulatory medical care survey results. J Emerg Med 2012;43:575-83.
- Driscoll DJ, Jacobsen SJ, Porter CJ, Wollan PC. Syncope in children and adolescents. J Am Coll Cardiol 1997;29:1039-45.
- Ganzeboom KS, Colman N, Reitsma JB, Shen WK, Wieling W. Prevalence and triggers of syncope in medical students. Am J Cardiol 2003;91:1006–8.
- Kapoor WN. Syncope. N Engl J Med 2000;343:1856–62.
- Massin MM, Bourguignont A, Coremans C, Comté L, Lepage P, Gérard P. Syncope in pediatric patients presenting to an emer- gency department. J Pediatr 2004;145:223–8.
- Brignole M, Alboni P, Benditt DG, Bergfeldt L, Blanc JJ, Thomsen PEB, et al. Guidelines on management (diagnosis and treatment) of syncope-update 2004. Executive Summary. Eur Heart J 2004;25:2054–72.
- Hegazy RA, Lotfy WN. The value of Holter monitoring in the assessment of pediatric patients. Indian Pacing Electrophysiol J 2007;7:204–14.
- Prodinger RJ, Reisdorff EJ. Syncope in children. Emerg Med Clin North Am 1998;16:617–26.
- Landau WM, Nelson DA. Clinical neuromythology XV. Feinting science: Neurocardiogenic syncope and collateral vasovagal confusion. Neurology 1996;46:609–18.
- Syncope or seizure? The diagnostic value of synchronous tilt testing and video-EEG monitoring in children with transient loss of consciousness. Epilepsy Behav 2012;24:93–6.
Details
| Other ID | JA79YC94AN |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | August 1, 2014 |
| Submission Date | August 1, 2014 |
| Published in Issue | Year 2014 Volume: 8 Issue: 2 |
The publication language of Turkish Journal of Pediatric Disease is English.
Manuscripts submitted to the Turkish Journal of Pediatric Disease will go through a double-blind peer-review process. Each submission will be reviewed by at least two external, independent peer reviewers who are experts in the field, in order to ensure an unbiased evaluation process. The editorial board will invite an external and independent editor to manage the evaluation processes of manuscripts submitted by editors or by the editorial board members of the journal. The Editor in Chief is the final authority in the decision-making process for all submissions. Articles accepted for publication in the Turkish Journal of Pediatrics are put in the order of publication, with at least 10 original articles in each issue, taking into account the acceptance dates. If the articles sent to the reviewers for evaluation are assessed as a senior for publication by the reviewers, the section editor and the editor considering all aspects (originality, high scientific quality and citation potential), it receives publication priority in addition to the articles assigned for the next issue.
The aim of the Turkish Journal of Pediatrics is to publish high-quality original research articles that will contribute to the international literature in the field of general pediatric health and diseases and its sub-branches. It also publishes editorial opinions, letters to the editor, reviews, case reports, book reviews, comments on previously published articles, meeting and conference proceedings, announcements, and biography. In addition to the field of child health and diseases, the journal also includes articles prepared in fields such as surgery, dentistry, public health, nutrition and dietetics, social services, human genetics, basic sciences, psychology, psychiatry, educational sciences, sociology and nursing, provided that they are related to this field. can be published.