ABSTRACT
Ictal tachycardia and bradycardia are common arrhythmias; however, ictal sinus pause and asystole are rare. Ictal arrhythmia is mostly reported in adults with temporal lobe epilepsy. Recently, ictal arrhythmia was recognized as a major warning sign of sudden unexpected death in epilepsy. We present an interesting case of a child with ictal sinus pause and asystole. A 27-month-old girl was hospitalized due to 5 episodes of convulsions during the past 2 days. Results of routine electroencephalography (EEG) were normal, but she experienced brief generalized tonic seizure for 3 days. During video-monitored EEG and echocardiography (ECG), she showed multiple myoclonic seizures simultaneously or independently, as well as frequent sinus pauses. After treatment with valproic acid, myoclonus and generalized tonic seizures were well controlled and only 2 sinus pauses were seen on 24-hour Holter ECG monitoring. Sinus dysfunction should be recognized on EEG, and it can sometimes be treated successfully with only antiepileptic medication.
Subject(s)
Adult , Child , Child, Preschool , Female , Humans , Arrhythmias, Cardiac , Bradycardia , Echocardiography , Electrocardiography , Electroencephalography , Epilepsy , Epilepsy, Temporal Lobe , Heart Arrest , Myoclonus , Seizures , Tachycardia , Valproic AcidABSTRACT
A 73 year-old male presented with recurrent episodes of syncope associated with swallowing. Head up tilt test revealed positive response and electrocardiogram revealed a sinus pause with swallowing of carbonated beverages. Underlying esophageal or cardiac disease was not found after evaluation. These findings suggest that a disturbance in the autonomic feedback loop of cardiovascular reflex led to the vasovagal syncope and swallow syncope in this patient. We experienced a case of swallow syncope with sinus pause and vasovagal syncope diagnosed by head up tilt test. This is the first case in Korea that presented with both swallow syncope and vasovagal syncope.