Senkop ve Ayırıcı Tanısı
Özet
Senkop, serebral kan akımındaki ani ve geçici azalmaya bağlı olarak akut bilinç ve postur kaybıdır. Pediatrik yaş grubunda, özellikle adolesan dönemde sık görülür. Senkopun ayırıcı tanısı oldukça geniştir. Atakların büyük çoğunluğu iyi huyludur ve vazovagal senkop veya basit bayılma olarak bilinir. Nadiren aritmi, yapısal kalp hastalığı veya kalp dışı hastalıklar gibi ciddi bir durumun ilk bulgusu olabilir. Bundan dolayı doğru tanı ve tedavi hayati öneme sahiptir. Ayrıntılı öykü ve fizik muayene ayırıcı tanıda oldukça önemlidir.
Syncope is an acute loss of consciousness and posture due to a sudden and temporary decrease in cerebral blood flow. It is common in the pediatric age group, especially in adolescence. The differential diagnosis of syncope is quite broad. The vast majority of attacks are benign and are known as vasovagal syncope or simple fainting. Rarely, arrhythmia may be the first sign of a serious condition such as structural heart disease or non-cardiac disease. Therefore, correct diagnosis and treatment are vital. Detailed history and physical examination are very important in differential diagnosis.
Referanslar
Lewis DA, Dhala A. Syncope in the pediatric patient. The cardiologist's perspective. Pediatr Clin North Am. 1999;46(2):205-219.
Driscoll DJ, Jacobsen SJ, Porter CJ, Wollan PC. Syncope in children and adolescents. J Am Coll Cardiol. 1997;29(5):1039-1045.
Friedman KG, Alexander ME. Chest pain and syncope in children: A practical approach to the diagnosis of cardiac disease. J Pediatr. 2013;163:896-901.
Scott WA. Evaluating the child with syncope. Pediatr Ann. 1991;20(7):350-359.
Pratt JL, Fleisher GR. Syncope in children and adolescents. Pediatr Emerg Care. 1989;5(2):80-82.
Kapoor WN. Syncope. N Engl J Med 2000;343:1856.
Gillette PC, Garson A Jr. Sudden cardiac death in the pediatric population. Circulation 1992;85:I64.
Park, M. D., & Salamat, M. (2021). Park’s pediatric cardiology for practitioners. 7th ed. Elsevier.
Moodley M. Clinical approach to syncope in children. Semin Pediatr Neurol. 2013;20(1):12-17
Anderson JB, Willis M, Lancaster H, Leonard K, Thomas C. The Evaluation and Management of Pediatric Syncope. Pediatr Neurol. 2016; 55:6-13
Bayram AK, Pamukcu O, Per H. Current approaches to the clinical assessment of syncope in pediatric population. Childs Nerv Syst. 2016;32(3):427-436.
Mosqueda-Garcia R, Furlan R, Tank J, Femandez R. The elusive pathophysiology of neurally mediated syncope Circulation 2000; 102:2898-2906.
Huff JS, Decker WW, Quinn JV et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with syncope. Ann Emerg Med 2007; 494:431- 44.
Lewis AL, Zlotocha J, Henke L. Specificity of headup tilt testing in adolescents: Effects of various degrees of tilt challenge in normal control subjects. J Am CollCardiol 1997; 30:1057–60.
Arnold AC, Ng J, Lei L, Raj SR. Autonomic Dysfunction in Cardiology: Pathophysiology, Investigation, and Management. Can J Cardiol. 2017;33(12):1524-1534.
Stewart MJ. Autonomic nervous system dysfunction in adolescents with postural orthostatic tachycardia syndrome and chronic Table 3. Blood Pressure, Pulse, Urine-specific Gravity and Orthostatic Hypotension in Children With and Without Fever Variable (Mean 6 SD) Fever No Fever p-Value Test Used Temperature in ED (C) 38.5 6 0.8 36.7 6 0.3
The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology 1996;46:1470.
Stewart MJ. Transient orthostatic hypotension is common in adolescents. J Pediatr 2002;140:418–23.
Stewart MJ. Orthostatic intolerance in pediatrics. J Pediatr 2002; 140:404–11.
Grubb BP, Kanjwal Y, Kosinski DJ. The postural tachycardia syndrome: a concise guide to diagnosis and management. J Cardiovasc Electrophysiol. 2006;17(1):108-112. doi:10.1111/j.1540-8167.2005.00318.x
Raj SR. The Postural Tachycardia Syndrome (POTS): pathophysiology, diagnosis & management. Indian Pacing Electrophysiol J. 2006;6(2):84-99. Published 2006 Apr 1.
Sezer S, Onan S H, Baykan A, et al. A Rare Cause of Syncope in Children: Postural Orthostatic Tachycardia Syndrome - Case Report. Journal of Child. 2010;10(2):98-99.
Thomson HL, Atherton JJ, Khafagi FA, Frenneaux MP. Failure of reflex venoconstriction during exercise in patients with vasovagal syncope. Circulation. 1996;93(5):953-959. doi:10.1161/01.cir.93.5.953
Katz RM. Cough syncope in children with asthma. J Pediatr 1970;77:48–51.
Kerr A, Derbes VJ. The syndrome of cough syncope. Ann Intern Med 1953;39:1240–53
McCann WS, Bruce RA, Lovejoy Jr FW, et al. Tussive syncope: observation on the disease formerly called laryngeal epilepsy with report of two cases. Arch Intern Med 1949;84:845–56.
Chakravarty A. Why women do not get micturition syncope? A hypothesis. Medical Hypotheses 2003; 61:463-464.
Friedman KG, Alexander ME. Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease. J Pediat. 2013; 163:896-901.
Massin, Martial M et al. “Syncope in pediatric patients presenting to an emergency department.” The Journal of pediatrics vol. 145,2 (2004): 223-8.
Baykan, A., Vural, Ç. (2022) Uzun QT sendromu ve epilepsi. In: Kumandaş, S., Canpolat, M. (eds) Temel pediatrik nörtoloji tanı ve tedavi. 3. Basım. Akademisyen kitapevi. Ankara. https://doi.10.37609/akya.2032
Eliasson HJ, Nygren I, Rydberg A, Sjöborg A, Alpman M. National guidelines for mangement of LQTS. Kongenitalt långt QT syndrom LQTS Vårdprogram barn och ungdomar (Swedish): Swedish Pediatric Cardiology Society; 2016.
Sidhu S, Marine JE. Evaluating and managing bradycardia. Trends Cardiovasc Med. 2020;30(5):265-272.
Vilcant V, Hai O. Left Ventricular Outflow Tract Obstruction. In: StatPearls. Treasure Island (FL): StatPearls Publishing; December 23, 2022.
Rabinovitch M. Pathophysiology of pulmonary hypertension. In: Allen H, et al., eds. Moss and Adams’ Heart Disease in Infants, Children, and Adolescents. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2008:1322-1354.
Shahjehan RD, Bhutta BS. Coronary Artery Disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; February 9, 2023.
Candelino M, Tagi VM, Chiarelli F. Cardiovascular risk in children: a burden for future generations. Ital J Pediatr. 2022;48(1):57. Published 2022 Apr 11.
Lipshultz SE, Cochran TR, Briston DA, et al. Pediatric cardiomyopathies: causes, epidemiology, clinical course, preventive strategies and therapies. Future Cardiol. 2013;9(6):817-848.
Bergfeldt L. Differential diagnosis of cardiogenic syncope and seizure disorders. Heart. 2003;89:353-358.
Andrighetto AG, John AB, Barbisan JN, Taborda JG. Medically unexplained syncope and its relationship to psychiatric disorders. Arq Bras Cardiol. 1999;72:751-760.
Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia. 2010;51:676-685.
Engel Jr J. Report of the ILAE classification core group. Epilepsia. 2006;47:1558-1568.
Alcocer F, David M, Goodman R, Jain SK, David S. A forgotten vascular disease with important clinical implications. Subclavian steal syndrome. Am J Case Rep. 2013;14:58-62.
Zaidi HA, Albuquerque FC, Chowdhry SA, Zabramski JM, Ducruet AF, Spetzler RF. Diagnosis and management of bow hunter’s syndrome: 15-year experience at barrow neurological institute. World Neurosurg. 2014;82:733-738.
Busse H, Harrop T, Gunnell D, Kipping R. Prevalence and associated harm of engagement in self-asphyxial behaviours (‘choking game’) in young people: a systematic review. Arch Dis Child. 2015;100: 1106-1114.
Goldberg EM, Schwartz ES, Younkin D, Myers SR. Atypical syncope in a child due to a colloid cyst of the third ventricle. Pediatr Neurol. 2011;45:331-334.
Rosenstengel C, Baldauf J, Muller JU, Schroeder HW. Sudden intraaqueductal dislocation of a third ventricle ependymoma causing acute decompensation of hydrocephalus. J Neurosurg Pediatr. 2011; 8:154-157.
Pollack IF, Schor NF, Martinez AJ, Towbin R. Bobble-head doll syndrome and drop attacks in a child with a cystic choroid plexus papilloma of the third ventricle. Case report. J Neurosurg. 1995;83: 729-732.
SGrubb BP, Olshansky B. Syncope: mechanisms and management. 2nd ed. Malden, Mass: Blackwell Futura; 2005:368. xiii.
American Psychiatric Association. Task Force on DSM-IV, Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed. Washington, DC: American Psychiatric Association; 2000:943. xxxvii.
Jaghab K, Skodnek KB, Padder TA. Munchausen’s syndrome and other factitious disorders in children: case series and literature review. Psychiatry (Edgmont). 2006;3:46-55.
David JE, Yale SH, Vidaillet HJ. Hyperventilation-induced syncope: no need to panic. Clin Med Res. 2003;1:137-139.
Brigo F, Storti M, Lochner P, et al. Tongue biting in epileptic seizures and psychogenic events: an evidence-based perspective. Epilepsy Behav. 2012;25:251-255.
Rodday AM, Triedman JK, Alexander ME, et al. Electrocardiogram screening for disorders that cause sudden cardiac death in asymptomatic children: a meta-analysis. Pediatrics. 2012;129:e999-e1010.
Steinberg LA, Knilans TK. Costs and utility of tests in the evaluation of the pediatric patients with syncope. Prog Pediatr Cardiol. 2001; 13:139-149.
Schroeder C, Bush VE, Norcliffe LJ, et al. Water drinking acutely improves orthostatic tolerance in healthy subjects. Circulation. 2002;106:2806-2811.
El-Sayed H, Hainsworth R. Salt supplement increases plasma volume and orthostatic tolerance in patients with unexplained syncope. Heart. 1996;75:134-140.
Yi S, Kong YH, Kim SJ. Fludrocortisone in Pediatric Vasovagal Syncope: A Retrospective, Single-Center Observational Study. J Clin Neurol. 2021;17(1):46-51.
Sheldon RS, Morillo CA, Klingenheben T, Krahn AD, Sheldon A, Rose MS. Age-dependent effect of β-blockers in preventing vasovagal syncope. Circ Arrhythm Electrophysiol. 2012;5(5):920-926.
Sheldon R, Faris P, Tang A, et al. Midodrine for the Prevention of Vasovagal Syncope : A Randomized Clinical Trial. Ann Intern Med. 2021;174(10):1349-1356.
Grubb BP, Samoil D, Kosinski D, Kip K, Brewster P. Use of sertraline hydrochloride in the treatment of refractory neurocardiogenic syncope in children and adolescents. J Am Coll Cardiol. 1994;24(2):490-494.
Referanslar
Lewis DA, Dhala A. Syncope in the pediatric patient. The cardiologist's perspective. Pediatr Clin North Am. 1999;46(2):205-219.
Driscoll DJ, Jacobsen SJ, Porter CJ, Wollan PC. Syncope in children and adolescents. J Am Coll Cardiol. 1997;29(5):1039-1045.
Friedman KG, Alexander ME. Chest pain and syncope in children: A practical approach to the diagnosis of cardiac disease. J Pediatr. 2013;163:896-901.
Scott WA. Evaluating the child with syncope. Pediatr Ann. 1991;20(7):350-359.
Pratt JL, Fleisher GR. Syncope in children and adolescents. Pediatr Emerg Care. 1989;5(2):80-82.
Kapoor WN. Syncope. N Engl J Med 2000;343:1856.
Gillette PC, Garson A Jr. Sudden cardiac death in the pediatric population. Circulation 1992;85:I64.
Park, M. D., & Salamat, M. (2021). Park’s pediatric cardiology for practitioners. 7th ed. Elsevier.
Moodley M. Clinical approach to syncope in children. Semin Pediatr Neurol. 2013;20(1):12-17
Anderson JB, Willis M, Lancaster H, Leonard K, Thomas C. The Evaluation and Management of Pediatric Syncope. Pediatr Neurol. 2016; 55:6-13
Bayram AK, Pamukcu O, Per H. Current approaches to the clinical assessment of syncope in pediatric population. Childs Nerv Syst. 2016;32(3):427-436.
Mosqueda-Garcia R, Furlan R, Tank J, Femandez R. The elusive pathophysiology of neurally mediated syncope Circulation 2000; 102:2898-2906.
Huff JS, Decker WW, Quinn JV et al. Clinical policy: critical issues in the evaluation and management of adult patients presenting to the emergency department with syncope. Ann Emerg Med 2007; 494:431- 44.
Lewis AL, Zlotocha J, Henke L. Specificity of headup tilt testing in adolescents: Effects of various degrees of tilt challenge in normal control subjects. J Am CollCardiol 1997; 30:1057–60.
Arnold AC, Ng J, Lei L, Raj SR. Autonomic Dysfunction in Cardiology: Pathophysiology, Investigation, and Management. Can J Cardiol. 2017;33(12):1524-1534.
Stewart MJ. Autonomic nervous system dysfunction in adolescents with postural orthostatic tachycardia syndrome and chronic Table 3. Blood Pressure, Pulse, Urine-specific Gravity and Orthostatic Hypotension in Children With and Without Fever Variable (Mean 6 SD) Fever No Fever p-Value Test Used Temperature in ED (C) 38.5 6 0.8 36.7 6 0.3
The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology 1996;46:1470.
Stewart MJ. Transient orthostatic hypotension is common in adolescents. J Pediatr 2002;140:418–23.
Stewart MJ. Orthostatic intolerance in pediatrics. J Pediatr 2002; 140:404–11.
Grubb BP, Kanjwal Y, Kosinski DJ. The postural tachycardia syndrome: a concise guide to diagnosis and management. J Cardiovasc Electrophysiol. 2006;17(1):108-112. doi:10.1111/j.1540-8167.2005.00318.x
Raj SR. The Postural Tachycardia Syndrome (POTS): pathophysiology, diagnosis & management. Indian Pacing Electrophysiol J. 2006;6(2):84-99. Published 2006 Apr 1.
Sezer S, Onan S H, Baykan A, et al. A Rare Cause of Syncope in Children: Postural Orthostatic Tachycardia Syndrome - Case Report. Journal of Child. 2010;10(2):98-99.
Thomson HL, Atherton JJ, Khafagi FA, Frenneaux MP. Failure of reflex venoconstriction during exercise in patients with vasovagal syncope. Circulation. 1996;93(5):953-959. doi:10.1161/01.cir.93.5.953
Katz RM. Cough syncope in children with asthma. J Pediatr 1970;77:48–51.
Kerr A, Derbes VJ. The syndrome of cough syncope. Ann Intern Med 1953;39:1240–53
McCann WS, Bruce RA, Lovejoy Jr FW, et al. Tussive syncope: observation on the disease formerly called laryngeal epilepsy with report of two cases. Arch Intern Med 1949;84:845–56.
Chakravarty A. Why women do not get micturition syncope? A hypothesis. Medical Hypotheses 2003; 61:463-464.
Friedman KG, Alexander ME. Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease. J Pediat. 2013; 163:896-901.
Massin, Martial M et al. “Syncope in pediatric patients presenting to an emergency department.” The Journal of pediatrics vol. 145,2 (2004): 223-8.
Baykan, A., Vural, Ç. (2022) Uzun QT sendromu ve epilepsi. In: Kumandaş, S., Canpolat, M. (eds) Temel pediatrik nörtoloji tanı ve tedavi. 3. Basım. Akademisyen kitapevi. Ankara. https://doi.10.37609/akya.2032
Eliasson HJ, Nygren I, Rydberg A, Sjöborg A, Alpman M. National guidelines for mangement of LQTS. Kongenitalt långt QT syndrom LQTS Vårdprogram barn och ungdomar (Swedish): Swedish Pediatric Cardiology Society; 2016.
Sidhu S, Marine JE. Evaluating and managing bradycardia. Trends Cardiovasc Med. 2020;30(5):265-272.
Vilcant V, Hai O. Left Ventricular Outflow Tract Obstruction. In: StatPearls. Treasure Island (FL): StatPearls Publishing; December 23, 2022.
Rabinovitch M. Pathophysiology of pulmonary hypertension. In: Allen H, et al., eds. Moss and Adams’ Heart Disease in Infants, Children, and Adolescents. Philadelphia, PA: Lippincott, Williams, and Wilkins; 2008:1322-1354.
Shahjehan RD, Bhutta BS. Coronary Artery Disease. In: StatPearls. Treasure Island (FL): StatPearls Publishing; February 9, 2023.
Candelino M, Tagi VM, Chiarelli F. Cardiovascular risk in children: a burden for future generations. Ital J Pediatr. 2022;48(1):57. Published 2022 Apr 11.
Lipshultz SE, Cochran TR, Briston DA, et al. Pediatric cardiomyopathies: causes, epidemiology, clinical course, preventive strategies and therapies. Future Cardiol. 2013;9(6):817-848.
Bergfeldt L. Differential diagnosis of cardiogenic syncope and seizure disorders. Heart. 2003;89:353-358.
Andrighetto AG, John AB, Barbisan JN, Taborda JG. Medically unexplained syncope and its relationship to psychiatric disorders. Arq Bras Cardiol. 1999;72:751-760.
Berg AT, Berkovic SF, Brodie MJ, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia. 2010;51:676-685.
Engel Jr J. Report of the ILAE classification core group. Epilepsia. 2006;47:1558-1568.
Alcocer F, David M, Goodman R, Jain SK, David S. A forgotten vascular disease with important clinical implications. Subclavian steal syndrome. Am J Case Rep. 2013;14:58-62.
Zaidi HA, Albuquerque FC, Chowdhry SA, Zabramski JM, Ducruet AF, Spetzler RF. Diagnosis and management of bow hunter’s syndrome: 15-year experience at barrow neurological institute. World Neurosurg. 2014;82:733-738.
Busse H, Harrop T, Gunnell D, Kipping R. Prevalence and associated harm of engagement in self-asphyxial behaviours (‘choking game’) in young people: a systematic review. Arch Dis Child. 2015;100: 1106-1114.
Goldberg EM, Schwartz ES, Younkin D, Myers SR. Atypical syncope in a child due to a colloid cyst of the third ventricle. Pediatr Neurol. 2011;45:331-334.
Rosenstengel C, Baldauf J, Muller JU, Schroeder HW. Sudden intraaqueductal dislocation of a third ventricle ependymoma causing acute decompensation of hydrocephalus. J Neurosurg Pediatr. 2011; 8:154-157.
Pollack IF, Schor NF, Martinez AJ, Towbin R. Bobble-head doll syndrome and drop attacks in a child with a cystic choroid plexus papilloma of the third ventricle. Case report. J Neurosurg. 1995;83: 729-732.
SGrubb BP, Olshansky B. Syncope: mechanisms and management. 2nd ed. Malden, Mass: Blackwell Futura; 2005:368. xiii.
American Psychiatric Association. Task Force on DSM-IV, Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed. Washington, DC: American Psychiatric Association; 2000:943. xxxvii.
Jaghab K, Skodnek KB, Padder TA. Munchausen’s syndrome and other factitious disorders in children: case series and literature review. Psychiatry (Edgmont). 2006;3:46-55.
David JE, Yale SH, Vidaillet HJ. Hyperventilation-induced syncope: no need to panic. Clin Med Res. 2003;1:137-139.
Brigo F, Storti M, Lochner P, et al. Tongue biting in epileptic seizures and psychogenic events: an evidence-based perspective. Epilepsy Behav. 2012;25:251-255.
Rodday AM, Triedman JK, Alexander ME, et al. Electrocardiogram screening for disorders that cause sudden cardiac death in asymptomatic children: a meta-analysis. Pediatrics. 2012;129:e999-e1010.
Steinberg LA, Knilans TK. Costs and utility of tests in the evaluation of the pediatric patients with syncope. Prog Pediatr Cardiol. 2001; 13:139-149.
Schroeder C, Bush VE, Norcliffe LJ, et al. Water drinking acutely improves orthostatic tolerance in healthy subjects. Circulation. 2002;106:2806-2811.
El-Sayed H, Hainsworth R. Salt supplement increases plasma volume and orthostatic tolerance in patients with unexplained syncope. Heart. 1996;75:134-140.
Yi S, Kong YH, Kim SJ. Fludrocortisone in Pediatric Vasovagal Syncope: A Retrospective, Single-Center Observational Study. J Clin Neurol. 2021;17(1):46-51.
Sheldon RS, Morillo CA, Klingenheben T, Krahn AD, Sheldon A, Rose MS. Age-dependent effect of β-blockers in preventing vasovagal syncope. Circ Arrhythm Electrophysiol. 2012;5(5):920-926.
Sheldon R, Faris P, Tang A, et al. Midodrine for the Prevention of Vasovagal Syncope : A Randomized Clinical Trial. Ann Intern Med. 2021;174(10):1349-1356.
Grubb BP, Samoil D, Kosinski D, Kip K, Brewster P. Use of sertraline hydrochloride in the treatment of refractory neurocardiogenic syncope in children and adolescents. J Am Coll Cardiol. 1994;24(2):490-494.
