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Cough syncope misinterpreted as epileptic seizure Volume 10, issue 3, September 2008

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  • Cough syncope misinterpreted as epileptic seizure
  • Cough syncope misinterpreted as epileptic seizure

Auteur(s) : Philippe Gelisse1, Pierre Genton2

1Epilepsy Unit, Hôpital Gui de Chauliac ; Research Unit “Movement Disorders” (URMA), Department of Neurobiology, Institute of Functional Genomics, CNRS UMR5203 - INSERM U661 - UM1, Montpellier
2Centre Saint Paul-H. Gastaut, Marseille, France

Article reçu le 15 Avril 2008, accepté le 21 Mai 2008

Using EEG-video monitoring, we recorded typical vasoplegic syncopes triggered by voluntary coughing (see video sequence) and the Valsava maneuver, in a 33-year-old patient referred with the diagnosis of generalized tonic-clonic seizures associated with coughing. Epilepsy had been suspected because the attacks were impressive and sometimes the loss of consciouness was associated with urinary and/or fecal incontinence. However, the attacks were associated with obesity, which was ascribed to the treatment of manic-depressive disorder with neuroleptics, obstructive sleep apnea, and heavy consumption of cigarettes. There were actually no signs of epilepsy. Brain MRI was normal with no Arnold-Chiari malformation.

Epileptic seizures and syncope sometimes pose diagnostic challenges (Spanaki et al. 2006; Perrig and Jallon, 2008). Generalized tonic-clonic seizures can be confused with syncopes because of the hypertonia and occasional jerks (Gelisse et al. 2007), but in syncope there is a brief period of unconsciousness with no post-ictal confusion. Syncopes are rarely accompanied by incontinence. Cough syncope, also called tussive syncope, was first described by Charcot in 1876 under the name “vertige laryngé” (Gelisse and Genton, 1997). It occurs usually in moderately obese, middle-aged men with broncho-pulmonary disorders. Loss of consciousness follows a bout of prolonged coughing. Syncope is due to lowered cerebral perfusion pressure as a consequence of increased intrathoracic pressure (Valsalva mechanism), culminating in an acute decline in cardiac output, which impairs cerebral venous return. Another proposed mechanism is a decrease in cerebral blood flow as a consequence of elevated cerebrospinal fluid pressure during coughing.