Objective: To describe the combination of tilt-induced vasovagal syncope (VVS) and psychogenic pseudosyncope (PPS) and aid its clinical recognition. Methods:We identified people with tilt-induced VVS/PPS from 2 tertiary syncope referral centers.For each case, 3 controls with tilt-induced VVS were selected at random from the same center. Clinical characteristics were compared between both groups adjusting for multiple comparisons. Conclusions: VVS/PPS presents with a complex phenotype. High attack frequency, delayed recovery of consciousness, apparent loss of consciousness .1 minute, ictal eye closure, atypical triggers, and the absence of prodromes may serve as indicators that PPS coincides with VVS. Transient loss of consciousness (TLOC) is a frequent presentation, with vasovagal syncope (VVS) as the most common cause.1 Establishing the cause of TLOC can be difficult, especially when individuals present with 2 conditions simultaneously. The most reliable diagnosis of TLOC is obtained if appropriate pathophysiologic data are recorded during an attack recognized as typical by the individual. Blood pressure (BP), heart rate (HR), or both are low during VVS, but tend to be high during psychogenic pseudosyncope (PPS). 2 We previously noted that PPS either preceded or followed VVS in 12 out of 800 tilt-table tests, a pattern we label here as VVS/ PPS.2 This parallels the situation of psychogenic epileptic seizures (PNESs), which are also found more often in people with epileptic seizures. [3][4][5] Our previous study demonstrated that individuals with PPS had longer periods of apparent TLOC and were more likely to have their eyes closed during apparent TLOC than those with VVS.2 A sudden head drop or sliding down the tilt table was more frequent in individuals with PPS, whereas those with VVS were more likely to exhibit jerking movements. People with VVS/PPS may present with a mixture of the 2 sets of features, but this has not yet been described. Early recognition of VVS/PPS is important to avoid excessive testing. VVS features are probably better known than those of PPS. This

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Background. Pregnancy has disease-modifying effects in MS. First trimester abortion might be followed by increased MS activity. MS with myelin oligodendrocyte glycoprotein (MOG) autoantibodies is a rare and agressive disease variant. Objectives. This case illustrates severe inflammatory reactivation after surgical abortion in MS patient who carries MOG antibodies. Methods. Case-report. Patient provided written informed consent for information and images to be published. Results. MRI and CSF biomarkers indicated high inflammatory activity post-abortion. Conclusions. Pregnancy termination in combination with MOG antibody carriership and termination of dimethyl fumarate treatment just prior abortion have had contributed to extensive reactivation of MS.

Background. Pregnancy has disease-modifying effects in MS. First trimester abortion might be followed by increased MS activity. MS with myelin oligodendrocyte glycoprotein (MOG) autoantibodies is a rare and agressive disease variant.Objectives. This case illustrates severe inflammatory reactivation after surgical abortion in MS patient who carries MOG antibodies.Methods. Case-report. Patient provided written informed consent for information and images to be published. Results. MRI and CSF biomarkers indicated high inflammatory activity post-abortion. Conclusions. Pregnancy termination in combination with MOG antibody carriership and termination of dimethyl fumarate treatment just prior abortion have had contributed to extensive reactivation of MS.