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Geçici bilinç kaybıyla başvuran çocuk olguların retrospektif değerlendirilmesi

Yıl 2022, Cilt: 13 Sayı: 47, 273 - 280, 15.12.2022
https://doi.org/10.17944/mkutfd.992966

Öz

Amaç: Çalışmanın amacı, geçici bilinç kaybı (GBK) yakınması ile başvuran çocuk olguların tanılarının aydınlatılması, anamnez, etiyoloji, özgeçmiş ve soygeçmiş, fizik muayene ve laboratuvar bulgularının, tedavilerinin retrospektif değerlendirilmesidir.

Yöntem: Çalışmaya Süleyman Demirel Üniversitesi Tıp Fakültesi Hastanesine GBK yakınmasıyla 1 Ağustos 2017 ile 1 Şubat 2020 tarihleri arasında çocuk polikliniklerine başvuran hastalar dahil edildi, kaydedilen anamnezleri, fizik muayene bulguları detaylı olarak geriye dönük incelendi. Yapılan biyokimyasal laboratuvar incelemeleri, elektrokardiyografi (EKG), transtorasik ekokardiyografi (EKO), 24 saatlik ritm Holter EKG, kraniyal manyetik rezonans (MR) görüntüleme, elektroensefalografi (EEG) retrospektif olarak tanıya ve tedaviye yönelik değerlendirildi.

Bulgular: Hastaların 110’u (%68.8) kız, 50’si (%31.2) erkek idi. Hastaların ortalama yaşı 11.4 (±4.8) idi. Hastaların geçirdikleri ortalama GBK sayısı 1.6 (±1.2) idi. Bu çalışmadaki hastaların %33’ü tekrarlayan GBK atakları ile başvurmuştu. Bu çalışmada GBK tanısına yönelik yapılan ileri incelemelerde en sık neden vazovagal senkop (VVS) (51 hasta, %31.9), ikinci olarak epilepsi/FK/AFK (febril konvülzyon/afebril konvülzyon) (41 hasta, %25.6), üçüncü olarak psikojenik senkop (28 hasta, %17.5) olarak saptanmıştır. Diğer nedenler de sırasıyla durumsal, katılma nöbeti, OH (ortostatik hipotansiyon), migren/SVO (serebrovasküler olay), kardiyojenik, BPPV (benign paroksizmal pozisyonel vertigo) olarak bulunmuştur. Hastalara yapılan biyokimyasal tetkikler, EKG, EKO, 24 saatlik ritm Holter EKG, EEG, kraniyal MR incelemeleri analiz edildi ve değerlendirildi.

Sonuç: GBK yakınmasıyla başvuran her hastadan ayrıntılı anamnez alınmalı, tam sistemik muayene yapılmalı ve EKG çekilmelidir. Kan testleri, EEG, EKO, nörogörüntüleme, 24 saatlik ritm Holter EKG değerlendirmeleri ön tanıya yönelik istenmelidir.

Kaynakça

  • Senkop Tanı ve Tedavi Kılavuzu. Türk Kardiyoloji Dern Arş 2009; 8: 135-170.
  • Vlahos AP, Tzoufi M, Katsouras CS, Barka T, Sionti I, Michalis LK, et al. Provocation of neuro¬cardiogenic syncope during head up tilt testing in children: comparison between isoproterenol and nitroglycerin. Pediatrics 2007; 119: 419-425. https://doi. org/10.1542/peds.2006-1862
  • Longin E, Reinhard J, von Buch C, Gerstner T, Lenz T, König S. Autonomic function in children and adolescents with neurocardiogenic syncope. Pediatr Cardiol 2008; 29: 763-770. https://doi.org/10.1007/s00246-008-9198-z
  • Bo I, Carano N, Agnetti N, Tchana B, Allegri V, Sommi M, et al. Syncope in children and adolescents: a two year experience at the Department of Pediatrics in Parma. Acta Biomed 2009; 80: 36-41.
  • Batra AS, Balaji S. Management of syncope in pediatric patients. Current Treatment Options Cardiovascular Medicine 2005; 7: 391-398. https://doi.org/10.1007/s11936-005-0023-1
  • Bayram A, Pamukcu O, Per H. Current approaches to the clinical assessment of syncope in pediatric population. Childs Nerv Syst 2016; 32: 427-436. https://doi.org/10.1007/s00381- 015-2988-8
  • Zhang Q, Du J, Wang C, Du Z, Wang L. Tang C. The diagnostic protocol in children and adolescents with syncope: A multi centre prospective study Acta Pediatrica 2009; 98(5): 879-884. https://doi.org/10.1111/j.1651-2227.2008.01195.x
  • Ikiz, MA, Çetin I, Ekici F, Güven A, Değerliyurt A, Köse G. Pediatric Syncope Is Detailed Medical History the Key Point for Differential Diagnosis? Pediatr Emer Care 2014; 30: 331-334. https://doi.org/10.1097/PEC.0000000000000123
  • Duras E, İrdem A, Korbeyli HK, Aygun F, Dursun H. Çocuk kardiyoloji polikliniğine senkop nedeniyle başvuran olguların etiyolojik olarak değerlendirilmesi, J Contemp Med 2018; 8(4): 345-349. https://doi.org/10.16899/gopctd.420597
  • Aslan Ö, Güneri S: Vazovagal Senkop. Türk Kardiyoloji Dern Arş 1999; 27: 637-646.
  • Kapoor WN. Syncope. N Engl J Med 2000; 343: 1856-62. https://doi.org/10.1056/NEJM200012213432507
  • Chen L, Zhang QY, Ingrid S, Chen JQ, Du JB. Aetiologic and clinical characteristics of syncope in Chinese children. Acta Pediatrica 2007; 96: 1505-10. https://doi.org/10.1111/j.1651- 2227.2007.00446.x
  • Usalp S, Kemal H, Yüksek Ü, Yaman B, Günsel A, Edebal O, et al. Is there any link between vitamin D deficiency and vasovagal syncope? Journal of Arrhythmia 2020; 36: 371-376. https://doi.org/10.1002/joa3.12309
  • Yılmaz Ü, Özdemir R, Katipoğlu N, Dağ T, Berksoy EA, Meşe T. Etiology of Syncope in Children and the Value of Neurologic and Cardiologic Investigations in Diagnosis . Turkish J Pediatr Dis 2014; 2: 64-70. https://doi.org/10.12956/tjpd.2014.50
  • Pektas A, Koken R, Koca HB. Serum vitamin B-12 in children presenting with vasovagal syncope. Asia Pac J Clin Nutr 2018; 27(1): 176-181. https://doi.org/10.6133/apjcn.022017.17
  • Raucci U, Scateni S, Tozzi AE, Drago F, Giordano U, Marcias M, et al. The Availability and the Adherence to Pediatric Guidelines for the Management of Syncope in the Emergency Department, J Pediatr 2014; 165: 967-72. https://doi. org/10.1016/j.jpeds.2014.06.064
  • Gonzalez J, Fernandez R, Angelats C, Ballestero Y, Martinez J, Mintegi S. Pilot Trial of the Performance of Electrocardiogram in the Evaluation of Childhood Syncope in the Emergency Department, Pediatric Emergency Care 2019; https://doi. org/10.1097/PEC.0000000000001864
  • Ritter S, Tani YL, Etheridge PS, Williams RV, Craig JE, Minich LL. What Is the Yield of Screening Echocardiography in Pediatric Syncope? Pediatrics 2000; 105(5). https://doi.org/10.1542/ peds.105.5.e58
  • Nordvig AS, Fong KT, Willey JZ, Thakur KT, Boehme AK, Vargas WS, et al. Potential Neurologic Manifestations of COVID-19, American Academy of Neurology 2020; 11(2): 135-146. https:// doi.org/10.1212/CPJ.0000000000000897

Retrospective evaluation for pediatric patients presenting with transient loss of consciousness complaint

Yıl 2022, Cilt: 13 Sayı: 47, 273 - 280, 15.12.2022
https://doi.org/10.17944/mkutfd.992966

Öz

Objective: With this study was aimed to evaluate for pediatric patients presenting with transient loss of consciousness complaint. To document according to etiology, patients were investigated about history, physical examination, diagnostic tests and medications.

Method: Children admitted to Suleyman Demirel University Faculty of Medicine with transient loss of consciousness complaint were included between August 2017 and February 2020. History of the cases, physical examination findings, the results of biochemical test-electrocardiogram (ECG) -transthoracic echocardiography- 24 hours rhythm Holter ECG monitorization-neuroimaging-electroencephalography have been recorded, after that analyzed and evaluated them retrospectively.

Results: A total of 160 children with transient loss of consciousness were constituted 110 (68.8%) girls, 50 (31.2%) boys. The mean age was 11.4 (±4.8) years. The mean number of transient loss of consciousness attacks of the cases was 1.6 (± 1.2). Thirty-three percent of our total episodes were recurrent transient loss of consciousness episodes. With the further investigations in this study were found the most relevant etiology as neurocardiogenic syncope (51 patients, 31.9%), secondly epileptic seizures/febrile/afebrile convulsions (41 patients, 25.6%), thirdly psychogenic syncope (28 patients, 17.5 %). The other causes were defined that situational, breath-holding spells, orthostatic hypotension, migraine/ cerebrovascular event, cardiogenic syncope, benign paroxysmal positional vertigo. In this study were analyzed and evaluated biochemical tests, ECG, echocardiography, 24 hours rhythm Holter ECG, electroencephalography, brain magnetic resonance imaging.

Conclusion: A detailed history, physical examination and ECG could be performed all patients presenting with transient loss of consciousness in children. The other further investigations would useful if definitive diagnosis is unknown via initial assessments.

Kaynakça

  • Senkop Tanı ve Tedavi Kılavuzu. Türk Kardiyoloji Dern Arş 2009; 8: 135-170.
  • Vlahos AP, Tzoufi M, Katsouras CS, Barka T, Sionti I, Michalis LK, et al. Provocation of neuro¬cardiogenic syncope during head up tilt testing in children: comparison between isoproterenol and nitroglycerin. Pediatrics 2007; 119: 419-425. https://doi. org/10.1542/peds.2006-1862
  • Longin E, Reinhard J, von Buch C, Gerstner T, Lenz T, König S. Autonomic function in children and adolescents with neurocardiogenic syncope. Pediatr Cardiol 2008; 29: 763-770. https://doi.org/10.1007/s00246-008-9198-z
  • Bo I, Carano N, Agnetti N, Tchana B, Allegri V, Sommi M, et al. Syncope in children and adolescents: a two year experience at the Department of Pediatrics in Parma. Acta Biomed 2009; 80: 36-41.
  • Batra AS, Balaji S. Management of syncope in pediatric patients. Current Treatment Options Cardiovascular Medicine 2005; 7: 391-398. https://doi.org/10.1007/s11936-005-0023-1
  • Bayram A, Pamukcu O, Per H. Current approaches to the clinical assessment of syncope in pediatric population. Childs Nerv Syst 2016; 32: 427-436. https://doi.org/10.1007/s00381- 015-2988-8
  • Zhang Q, Du J, Wang C, Du Z, Wang L. Tang C. The diagnostic protocol in children and adolescents with syncope: A multi centre prospective study Acta Pediatrica 2009; 98(5): 879-884. https://doi.org/10.1111/j.1651-2227.2008.01195.x
  • Ikiz, MA, Çetin I, Ekici F, Güven A, Değerliyurt A, Köse G. Pediatric Syncope Is Detailed Medical History the Key Point for Differential Diagnosis? Pediatr Emer Care 2014; 30: 331-334. https://doi.org/10.1097/PEC.0000000000000123
  • Duras E, İrdem A, Korbeyli HK, Aygun F, Dursun H. Çocuk kardiyoloji polikliniğine senkop nedeniyle başvuran olguların etiyolojik olarak değerlendirilmesi, J Contemp Med 2018; 8(4): 345-349. https://doi.org/10.16899/gopctd.420597
  • Aslan Ö, Güneri S: Vazovagal Senkop. Türk Kardiyoloji Dern Arş 1999; 27: 637-646.
  • Kapoor WN. Syncope. N Engl J Med 2000; 343: 1856-62. https://doi.org/10.1056/NEJM200012213432507
  • Chen L, Zhang QY, Ingrid S, Chen JQ, Du JB. Aetiologic and clinical characteristics of syncope in Chinese children. Acta Pediatrica 2007; 96: 1505-10. https://doi.org/10.1111/j.1651- 2227.2007.00446.x
  • Usalp S, Kemal H, Yüksek Ü, Yaman B, Günsel A, Edebal O, et al. Is there any link between vitamin D deficiency and vasovagal syncope? Journal of Arrhythmia 2020; 36: 371-376. https://doi.org/10.1002/joa3.12309
  • Yılmaz Ü, Özdemir R, Katipoğlu N, Dağ T, Berksoy EA, Meşe T. Etiology of Syncope in Children and the Value of Neurologic and Cardiologic Investigations in Diagnosis . Turkish J Pediatr Dis 2014; 2: 64-70. https://doi.org/10.12956/tjpd.2014.50
  • Pektas A, Koken R, Koca HB. Serum vitamin B-12 in children presenting with vasovagal syncope. Asia Pac J Clin Nutr 2018; 27(1): 176-181. https://doi.org/10.6133/apjcn.022017.17
  • Raucci U, Scateni S, Tozzi AE, Drago F, Giordano U, Marcias M, et al. The Availability and the Adherence to Pediatric Guidelines for the Management of Syncope in the Emergency Department, J Pediatr 2014; 165: 967-72. https://doi. org/10.1016/j.jpeds.2014.06.064
  • Gonzalez J, Fernandez R, Angelats C, Ballestero Y, Martinez J, Mintegi S. Pilot Trial of the Performance of Electrocardiogram in the Evaluation of Childhood Syncope in the Emergency Department, Pediatric Emergency Care 2019; https://doi. org/10.1097/PEC.0000000000001864
  • Ritter S, Tani YL, Etheridge PS, Williams RV, Craig JE, Minich LL. What Is the Yield of Screening Echocardiography in Pediatric Syncope? Pediatrics 2000; 105(5). https://doi.org/10.1542/ peds.105.5.e58
  • Nordvig AS, Fong KT, Willey JZ, Thakur KT, Boehme AK, Vargas WS, et al. Potential Neurologic Manifestations of COVID-19, American Academy of Neurology 2020; 11(2): 135-146. https:// doi.org/10.1212/CPJ.0000000000000897
Toplam 19 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Klinik Tıp Bilimleri
Bölüm Original Articles
Yazarlar

İpek Uysal 0000-0002-8979-434X

Mahmut Keskin 0000-0002-6826-2985

Yayımlanma Tarihi 15 Aralık 2022
Gönderilme Tarihi 10 Eylül 2021
Kabul Tarihi 21 Haziran 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 13 Sayı: 47

Kaynak Göster

Vancouver Uysal İ, Keskin M. Geçici bilinç kaybıyla başvuran çocuk olguların retrospektif değerlendirilmesi. mkutfd. 2022;13(47):273-80.