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Electroencephalography in syncope.
University of Pittsburgh, Pennsylvania, USA.
J Clin Neurophysiol 1997 May;14(3):197-209
NLM CIT. ID:
Electroencephalographic (EEG) findings in syncope
are reviewed. There are four major categories of syncope: neurally mediated
(neurocardiogenic), neurologic, decreased cardiac output, and orthostatic hypotension.
However, regardless of cause, whether the syncope is due to a vasovagal effect, a cardiac
arrhythmia, an epileptic seizure, or hypotension, EEG findings are similar and reflect
cerebral hypoperfusion. Initially there may be a slowing of background rhythms. This is
followed by high amplitude delta activity, maximal anteriorly. If the hypoperfusion
persists there is subsequent flattening of the EEG. The EEG returns to normal in the
reverse sequence. In cases with severe and prolonged ischemia, convulsive syncope may
occur at the time of the EEG flattening. Although not an epileptic phenomena, clinically
this is often mistaken for epilepsy. Conversely, epileptic disorders, such as the ictal
bradycardia syndrome, may occasionally mimic syncope. Therefore, in patients in whom EEGs
are performed for the evaluation of an episode of loss of consciousness, simultaneous ECG
should be used.
Autonomic Nervous System Diseases/COMPLICATIONS
Cardiac Output, Low/COMPLICATIONS
Peripheral Nervous System Diseases/COMPLICATIONS
When my office
lease expired at the end of 2004, I decided to turn it into a
"sabbatical" from my private practice. Many years ago, in my
grandfather's 89th year of life, he told me, "John, it is important
to smell the roses while you can still smell them." His life
gave living a very good reputation. It is also true that the
pursuit of that philosophy required my grandfather to to re-open his
assay office/ore market in Wickenburg, Arizona as a 75-year-old because
he had run a little short of retirement money. Thus, if blessed with his
luck and health, I'll be back.. --jjh