J Neurol Neurosurg Psychiatry ; Am J Prev Med ; EEG in cough syncope. Neurology ; Carotid blood velocity during cough studies in man. Stroke ; Cough syncope from constrictive pericarditis: a case report. Can J Cardiol ; Vasodepressor cough syncope masked by sleep apnea-induced asystole. J Cardiovasc Electrophysiol ;23 9 Respir Med ; 2 Cough syncope and tracheal compression secondary to a retrosternal goitre: looking for a pulmonary embolism.
BMJ Case Rep ;12 4. Syncope in the adult Chiari anomaly. Neurology ;28 7 Pericardial effusion presenting as cough syncope. Acute Med ;19 2 Case report: cough syncope in a U. Army aviator. Aviat Space Environ Med ; Intractable hiccups and syncope in multiple sclerosis.
Acta Neurol Scand ; Cough syncope misinterpreted as epileptic seizure. Epileptic Disord ;10 3 Neurocardiogenic syncope. N Engl J Med ; Cough syncope and gastroesophageal reflux. A self-observation by Paul Valery [in French]. Presse Med ;23 25 Cough syncope as a cause of traffic accident [in German]. Blutalkohol ;27 2 Physiologic relationships between intrathoracic, intraspinal, and arterial pressures.
Arterial, cerebrospinal and venous pressures in man during cough and strain. Am J Physiol ; Syncope as a presenting feature of hindbrain herniation with syringomyelia. J Neurol Neurosurg Psychiatry ;45 10 Syncope caused by cough-induced complete atrioventricular block.
Cough syncope mimicking epilepsy in asthmatic children. Can J Neurol Sci ; Comentarii de morborum historia et curatione. London: T Payne, Sudden illness as a cause of motor vehicle accidents. Br J Int Med ; Gastroesophageal reflux in chronic cough and cough syncope and the effect of antireflux treatment: case report and literature review.
Ann Otol Rhinol Laryngol ; 10 Orv Hetil ; Evaluation of the autonomic cardiovascular response in Arnold-Chiari deformities and cough syncope syndrome. Arch Neurol ; Cough syncope induced by enalapril. Chest ; Cough syncope: a complication of adult whooping cough. Br J Dis Chest ; Cough syncope in children with asthma. J Pediatr ; The syndrome of cough syncope. Ann Intern Med ; Cerebral concussion as a cause of cough syncope. Arch Intern Med ; Sharpey-Schafer was right: evidence for systemic vasodilatation as a mechanism of hypotension in cough syncope.
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A potential novel variant of hereditary sensory neuropathy in a year-old man with cough-induced syncope and vertebral artery dissection. Mayo Clin Proc ; Syncope, driving recommendations, and clinical reality: survey of patients.
Br Med J ; Laryngospasm: an atypical manifestation of severe gastroesophageal reflux disease GERD. Laryngoscope ; Syncope: driving advice is frequently overlooked. Postgrad Med J ; Chiari I malformation associated with atlanto-occipital assimilation presenting as orthopnea and cough syncope. J Clin Neurosci a;21 2 Chiari I malformation associated with atlanto-occipital assimilation presenting as orthopnea and cough syncope: a case report and review of literature.
J Neurol Surg Rep b;75 1 :e Transient cerebral circulatory arrest coincides with fainting in cough syncope. Tussive syncope: observations on the disease formerly called laryngeal epilepsy, with report of two cases. Arch Intern Med ;84 6 Cough syncope in heavy goods vehicle drivers. Anyone with syncope should receive an initial evaluation, including detailed physical and history examinations and measurement of blood pressure and heart rate, by a physician.
An ECG electrocardiogram also is recommended as part of an initial evaluation to provide information about the cause of syncope.
ECG is widely available and inexpensive and can provide information about the potential and specific cause of syncope for example, abnormal heart rhythms. Other tests, such as exercise stress test , Holter monitor and an echocardiogram , may be needed to rule out other cardiac causes.
An ECG also is recommended for children and young adults with syncope. Other noninvasive diagnostic testing may be needed if they're suspected of having congenital heart disease , cardiomyopathy or a heart rhythm disorder. If the initial evaluation is unclear, it may be useful for patients to undergo a tilt test. The blood pressure and heart rate will be measured while lying on a board and with the board tilted up. People with NMS usually will faint during the tilt, due to the rapid drop in blood pressure and heart rate.
When people are placed on their back again, blood flow and consciousness are restored. Patients with VVS and without a serious medical condition usually can be managed in an outpatient setting. For older adults, a comprehensive approach in collaboration with a geriatric expert can be helpful.
For people who are dehydrated, it may be beneficial to increase their salt and fluid intake to prevent syncope. That recommendation — as well as the removal or reduction of hypotensive drugs and diuretics — also is encouraged when appropriate and safe for people who've experienced situational syncope. Consuming more salt and fluids can benefit most pediatric patients, but the results are unclear in people with NMS. Other lifestyle changes, such as exercise, also can benefit pediatric patients.
When it comes to driving after a syncope episode, there are no restrictions for VVS patients who had no fainting spells in the previous year.
Cough Syncope Timothy C. Cause of cough syncope: Normal or exaggerated response to forceful cough. Abnormally sensitive cardio-depressor response to Valvalva straining Chiari Malformation Cough syncope patients do not exhibit more pronounced hypotension in response to cough than other fainters, but they also manifest an inappropriate cough-triggered blood pressure-heart rate relationship.
Evaluation of cough syncope: Physical examination should include at a minimum blood pressure and pulse, standing and supine cardiac exam Carotid sinus testing Check pulse and ideally blood pressure during Valsalva and coughing. Routine Laboratory Testing: ECG Autonomic testing, including tilt-table testing The tilt table test should include a valsalva and coughing to simulate the situation. MRI for Chiari malformation 24 hour holter for sick-sinus. EEG -- should be normal.
It may be helpful to exclude seizures. Gelisse, P. Genton According to Chao, A. Treatment Most effort is aimed at treating the cough with cough suppressants, and exhaling before coughing. References: Benditt, D. Chao, A.
Choi, Y. Lungs examination revealed prolonged experium with expiratory wheezing. In the department, a few attacks of cough syncope were observed while the patient was on continuous monitoring of ECG, blood pressure, and oxygen saturation.
No significant changes in heart rate and blood pressure were observed during these episodes. The patient was treated orally with azithromycin for 5 days, inhalation of budesonide and salbutamol, prednisone and her other previous medications. A gradual significant clinical improvement occurred with decline in the intensity and frequency of the coughing episodes until complete resolution of these episodes 1 week later, and termination of the syncopal attacks with termination of azithromycin treatment.
No violent episodes of coughing or syncope occurred during a follow-up period of 4 months. Syncope is a transient self-limited loss of consciousness due to acute global impairment of cerebral blood flow. The onset is rapid, duration is brief, and recovery is often spontaneous and complete. In cough syncope, loss of consciousness usually occurs immediately after a cough, and more commonly after prolonged bouts of violent coughing, lasting for seconds with rapid restoration of full consciousness.
It more commonly occurs in middle-aged, obese smoker males with obstructive lung disease [ ]. Until yet, more than cases of cough syncope have been reported in the medical literature [ 1 , ]. This syndrome could be accompanied with significant increase of morbidity and mortality as with any syncope. Numerous motor vehicle accidents resulting from cough syncope have been reported.
These reports include the death of two drivers and three pedestrians [ 1 ]. It seems likely that the real number of deaths due to cough syncope-related motor vehicle accidents is much more than is reported, particularly if it caused death of the driver, since in this case nobody can know what the cause of the accident was.
The precise pathophysiologic mechanism of cough syncope is not fully understood, and remains a matter of debate [ ]. Several mechanisms have been proposed in this regard. With continuous coughing, intra-thoracic pressure increases resulting in decrease in venous return, ventricular filling, cardiac output, and blood pressure [ 15 ].
Since cough syncope may occur without prolonged period of coughing, it has been suggested that baroreceptor mechanism via a baroreceptor-initiated neural vasodilation-bradycardia reflex, further reducing blood pressure, could be partly responsible for the syncope.
Hence, subjects susceptible for cough syncope exhibit greater hypotensive response to transient exaggerated intra-arterial pressure pulses. Both the magnitude and duration of the consequent hypotension are greater than in other fainters, and the hypotensive-triggered compensatory positive chronotropic response is absent or markedly suppressed [ 14 , 15 ].
Other suggested mechanisms indicates that the increased intra-thoracic pressure during coughing is transmitted to the cerebrospinal fluid, causing an acute pressure increase in the skull, compromising cerebral perfusion and resulting in syncope [ 16 , 21 ]. Complete atrioventricular block in patients with left bundle branch block [ 19 ], carotid sinus hypersensitivity [ 20 ], sinus arrest in patients with sick sinus [ 22 ], and synergistic effect between jugular venous reflex and plasma endothelin-1 levels [ 23 ] have also been suggested.
Simultaneous occurrence of multiple pathophysiological processes may be required to induce cough syncope [ 1 ].
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