Tilt–induced vasovagal syncope and psychogenic pseudosyncope: Overlapping clinical entities

Blad, Helene; Lamberts, Robert J.; Dijk, J. Gert van; Thijs, Roland D.

doi:10.1016/j.autneu.2015.07.148

Cited by 8 publications

(19 citation statements)

References 5 publications

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“…The history had to contain positive features of PPS such as closed eyes during attacks, a long duration, and high frequency. 7 Attack documentation required recording an event recognized as typical by patients or relatives during a tilt table test, comprising continuous blood pressure, ECG, EEG, and video, 8,9,19 or ictal home video or blood pressure recording. Patients with a positive history and attack documentation were classified as definite; those with a positive history without documentation were classified as probable.…”

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confidence: 99%

Long-term follow-up of psychogenic pseudosyncope

et al. 2016

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Objective: To determine the outcome of patients with psychogenic pseudosyncope (PPS) after communication of the diagnosis.Methods: This was a retrospective cohort study of patients with PPS referred in 2007 to 2015 to a tertiary referral center for syncope. We reviewed patient records and studied attack frequency, factors affecting attack frequency, health care use, and quality of life using a questionnaire. We explored influences on attack freedom and attack frequency in the 6 months before follow-up for age, sex, education level, duration until diagnosis, probability of diagnosis, additional syncope, and acceptance of diagnosis.Results: Forty-seven of 57 patients with PPS could be traced, of whom 35 (74%) participated.Twelve (34%) were attack-free for at least 6 months. The median time from diagnosis to follow-up was 50 months (range 6-103 months). Communicating and explaining the diagnosis resulted in immediate reduction of attack frequency (p 5 0.007) from the month before diagnosis (median one attack, range 0-156) to the month after (median one attack, range 0-16). In the 6 months before follow-up, the number of admissions The 3 main groups of apparent transient loss of consciousness are syncope, epileptic seizures, and psychogenic attacks.

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confidence: 99%

Long-term follow-up of psychogenic pseudosyncope

et al. 2016

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“…• To differentiate between vasovagal syncope and psychogenic TLOC [39,40]. • To study the timing between asystole and the onset of TLOC Asystole in VVS may occur too late to have been the prime cause of TLOC, making pacemaker implantation likely ineffective [36].…”

Section: Ttt Should Be Consideredmentioning

confidence: 99%

“…Adding video and EEG has limited clinical value in OH because TTT in OH forms rarely induces syncope, and if complaints occur, these usually concern presyncope only, not usually accompanied by EEG changes. For psychogenic TLOC, video and EEG recordings during TTT are very important, as they enable a definite diagnosis of psychogenic TLOC [2,39,40] and recognition of mixed presentations of psychogenic pseudosyncope and VVS [40]. A complete clinical identification of the presence of TLOC requires assessment of loss of responsiveness, abnormal motor control, amnesia for the period of apparent unconsciousness and a short duration [2,26].…”

Section: Video and Eeg Recordingsmentioning

confidence: 99%

Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness

et al. 2021

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An expert committee was formed to reach consensus on the use of tilt table testing (TTT) in the diagnosis of disorders that may cause transient loss of consciousness (TLOC) and to outline when other provocative cardiovascular autonomic tests are needed. While TTT adds to history taking, it cannot be a substitute for it. An abnormal TTT result is most meaningful if the provoked event is recognised by patients or eyewitnesses as similar to spontaneous events. The minimum requirements to perform TTT are a tilt table, a continuous beat-to-beat blood pressure monitor, at least one ECG lead, protocols for the indications stated below and trained staff. This basic equipment lends itself to the performance of (1) additional provocation tests, such as the active standing test, carotid sinus massage and autonomic function tests; (2) additional measurements, such as video, EEG, transcranial Doppler, NIRS, end-tidal CO2 or neuro-endocrine tests; and (3) tailor-made provocation procedures in those with a specific and consistent trigger of TLOC. TTT and other provocative cardiovascular autonomic tests are indicated if the initial evaluation does not yield a definite or highly likely diagnosis, but raises a suspicion of (1) reflex syncope, (2) the three forms of orthostatic hypotension (OH), i.e. initial, classic and delayed OH, as well as delayed orthostatic blood pressure recovery, (3) postural orthostatic tachycardia syndrome or (4) psychogenic pseudosyncope. A therapeutic indication for TTT is to teach patients with reflex syncope and OH to recognise hypotensive symptoms and to perform physical counter manoeuvres.

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“…The majority of patients with PNEEs are young women between 15 and 40 years of age. 5 Spells associated with a gradual loss of tone and sliding down have been reported in individuals with psychogenic pseudosyncope. 5 Video-EEG monitoring is considered the "gold standard" in distinguishing between epileptic and nonepileptic attacks.…”

Section: Sectionmentioning

confidence: 99%

“…5 Spells associated with a gradual loss of tone and sliding down have been reported in individuals with psychogenic pseudosyncope. 5 Video-EEG monitoring is considered the "gold standard" in distinguishing between epileptic and nonepileptic attacks. 6 Our patient's history of falls with loss of consciousness, improvement with positional changes, and characteristic prodromal symptoms may suggest syncope or presyncope.…”

Section: Sectionmentioning

confidence: 99%

Clinical Reasoning: An unusual cause of indeterminate spells

et al. 2016

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A 38-year-old, right-handed woman presented to the epilepsy clinic for evaluation of recurrent spells. These spells are characterized by an aura of a "rushing" cephalic sensation and a sense of "spaciness" or "dizziness" followed by loss of awareness with subsequent amnesia for the event. During these events, the patient is observed by family to sit down and slump forward or fall, followed by hyperventilation and occasionally staring, for up to 3 minutes. There is no head turn, eye deviation, or abnormal body movements. Postictally, she reports generalized weakness without focality and confusion. The spells occurred sporadically for 8 years, but recently increased in frequency to 5 to 20 times per day. Triggers included lack of sleep, stress, and various food products. The patient reported some improvement with levetiracetam therapy at 1,500 mg twice daily.The patient was hospitalized for head injury from a motor vehicle accident at 16 years of age. She was amnestic for the event but was told that there were "contusions" in her brain. She endorses significant psychosocial stressors including a recent divorce and loss of her business. She reports a 10 pack-year history of smoking but denies excessive use of alcohol or illicit drugs. Neurologic examination at presentation was unremarkable. Basic laboratory tests including electrolytes, random blood glucose, and drug screening were normal. Likewise, ECG was normal. Outside EEGs reported left temporal slowing. Seizure protocol brain MRI showed multiple linear T2 hyperintensity, most prominent subcortically in the left frontal lobe, presumably posttraumatic (figure, A).

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Tilt–induced vasovagal syncope and psychogenic pseudosyncope: Overlapping clinical entities

Cited by 8 publications

References 5 publications

Long-term follow-up of psychogenic pseudosyncope

Long-term follow-up of psychogenic pseudosyncope

Recommendations for tilt table testing and other provocative cardiovascular autonomic tests in conditions that may cause transient loss of consciousness

Clinical Reasoning: An unusual cause of indeterminate spells

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