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IMAGING IN CARDIOLOGY

An unusual case of syncope

F.R. Menken-Negroiu, J.A. Hillers, G.A.M. Verheul, J.O. van Dobbenburgh

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Figure 1. The onset oft/n abnormal right temporal elecrical activity on the EEG. K 31-year-old woman presented to the emergency

Aroom because of repetitive syncopes. Physical

examination showed an apathetic woman with normal heart rate and blood pressure. Several periods of extreme bradycardia were recorded while the patient F.R. Monken-Negrolu JJL Hilles J.o. van Dobbenburgh Departrnent of Cardiology G.A.M. Verheul Department of Neurology, Groene Hart Hospital, PO Box 1098, 2800 BB Gouda Correspondence to: J.O. van Dobbenburgh E-mail: [email protected]

Netherlands Heart Journal, Volume 12, Number 3, March 2004

developed temporary syncopes without neurological manifestations. Simultaneous EEG/ECG recordings showed abnormal electrical activity in the right temporal lobe (figure 1) with extreme sinus bradycardia occurring about seven seconds after ictal onset, followed by sinus arrest and an escape rhythm of approximately 12 beats/min (figure 2). Normal heart rate and EEG were regained at the end of each seizure (figure 3). During anticonvulsant therapy the repetitive episodes of EEG abnormalities and concomitant bradycardia disappeared. Epileptic-induced bradycardia with the ictal focus in the right temporal lobe was diagnosed. An epileptic aetiology is seen in less than 2% of all cases of syncope. In the majority ofcases concomitant tachyarrhythmia appears, ictal bradycardia is a rare

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An unusual case of syncope.

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