[Indaemed_Freelist.Org] Re: [indaemed] Re: Syncope evaluation [was Re: Re: NMS]
- From: USM Bish <bish@xxxxxxxxxxx>
- To: indaemed@xxxxxxxxxxxxx
- Date: Sun, 21 Mar 2004 23:41:34 +0530
On Sun, Mar 21, 2004 at 01:39:22PM +0530, SS Mishra wrote:
> First of all, VVS is not essentially a baroreceptor induced
> phenomenon!!!!!!!
This is a Shoib Akhtar delivery whizzing past the ears, I am
glancing at the leg umpire, should he signal a no ball. Moin
Khan has just about managed to glove the ball 9 feet above !
This is a flame bait, and I would avoid biting it for the
moment lest we digress once again. I will transfer this to
another thread !
What we need is a fair explanation to the facets brought out in
the initial report of the medical officer after the first
syncope episode. The salient features being:
o Past history of intense psychological pressures, with maybe,
associated sleep disturbances. (He was anxious since he was
scheduled to fly his first solo sortie that day. He had been
sleeping for about four to five hours each night for the past
3 to 4 days instead of his usual seven to eight hours, busy
preparing for Aviation Medicine Final test).
o History of a freeze response before syncope (After narrating
the emergency procedure, he continued to stand still for a
couple of minutes)
o H/O preceding ANS mediated symptoms (when he felt dizzy, had
blurring of vision and cold sweating before fainting).
o A genuine spell of unconsciousness (He fell flat on the face,
sustaining a laceration wound on his chin).
o No convulsive episodes (DMO, who was present for the pre-
flight medical briefing, did not observe any jerking move-
ments of limbs, incontinence, tongue bite or any other sugg-
estive signs of seizures).
o Post syncopal recovery spontaneous within few minutes. (He
found that the patient was sweating, looked pale and had a
pulse rate of 54 beats per min. He regained consciousness
spontaneously in a few minutes and could recollect the
events preceding the faint).
o History suggestive of periorbital (and probably perioral)
myoclonia. (However, while being carried on a stretcher he
felt "too tired" to open his eyes or to respond to verbal
command).
o Residual lethargy. (The patient was feeling unduly fatigued
on the day of this episode).
o He has had 2 syncopal attacks under 30,000 ft of hypoxia and
I assume the description would be similar except for the
stated absence of the myoclonic component, and possibly the
ensuing lethargy.
I find it difficult to explain these as a vascular phenomenon
alone, and feel that there is a central component. Whether it
is an absence seizure or not is another issue ... but it HAS
to be something central ... Let us see if we can get at some-
thing.
If you support the VVS theory, it would be nice if you could
explain the above findings based on the same, (baro-receptor
mediated, centrally mediated, or whatever the current trend of
thinking these days is, on the subject).
Just a Q
Bish
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