Neurocardiogenic convulsive syncope - differential diagnosis, pathophysiology and therapy. A case report

Neurocardiogenic convulsive syncope as a disease at the border between card iovascular and neurologic dysfunction can pose considerable diagnostic chal lenges. We report on the case of a 19 year-old female patient with recurren t neurocardiogenic convulsive syncope where the time from the onset of symp toms to the correct diagnosis and initiation of an effective therapy spanne d more than three years. Based on this case report, we discuss differential diagnosis, pathophysiology and therapy of this disorder of autonomic cardi ovascular regulation. Neurocardiogenic convulsive syncope should be conside red whenever a patient has both syncope that exhibits a typical cardiovascu lar pattern (e.g., fainting of short duration with rapid reorientation phas e) and prolonged loss of consciousness with characteristic neurological fea tures (e.g., cerebral seizures with postictal state of confusion). Head-up tilt testing, introduced into clinical practice in 1986, is an efficient to ol to diagnose neurocardiogenic syncope with comparatively high sensitivity in patients with recurrent syncope of unknown origin. Besides orthostatic training and pharmacotherapy, permanent dual-chamber cardiac pacing has gai ned increasing importance as treatment for cardioinhibitory forms of neuroc ardiogenic syncope.