OVERVIEW
Cough syncope syndrome is a group of conditions characterized by a transient loss of consciousness that occurs when coughing, which recovers rapidly on its own without leaving any sequelae. However, it is susceptible to injuries due to falls. Therefore, it should be diagnosed and treated promptly to minimize its complications. The syndrome is most common in middle-aged men and can occur in all age groups, with unknown causes.
Causes
The syndrome is most common in male patients with chronic respiratory diseases (e.g., chronic bronchitis, emphysema, etc.), and can also be seen in atrioventricular block, obstructive cardiomyopathy, carotid sinus hypersensitivity, atherosclerosis, and so on. Pathogenesis for violent coughing chest, intra-abdominal pressure rises sharply, so that the venous return blood volume is reduced, cardiac output is reduced, resulting in transient cerebral ischemia; at the same time, coughing chest, intra-abdominal pressure rises rapidly can also be transmitted to the intracranial cavity through the subarachnoid space, so that the cranial pressure rises, the pressure of the cerebral vessels resulting in cerebral ischemia; in addition, coughing cerebrospinal fluid pressure rises rapidly, which can make the brain pressured to produce a concussion-like effect.
Symptoms
Loss of consciousness occurs immediately after severe coughing, generalized hypotonia, pallor, weak pulse, standing people may fall, severe cases have facial muscle and limb twitching, cyanosis, etc.. In mild cases, there may be no loss of consciousness. After a few seconds to a few minutes, the breathing gradually becomes regular, and then the patient becomes conscious. There is no obvious headache or drowsiness after the attack, and the number of attacks is variable.
Examination
1. Cerebrospinal fluid
Cerebrospinal fluid pressure rises rapidly when coughing.
2. Electroencephalogram
During the seizure, the EEG shows bilateral synchronized symmetrical spindle waves with a frequency of 2-3 cycles/second and a duration of 3-4 seconds. Interictal EEG is normal.
Diagnosis
Diagnosis can be made on the basis of the history of the above diseases, the above clinical manifestations and auxiliary examinations, and the exclusion of epilepsy or other causes of syncope and other conditions.
Differential diagnosis
Epilepsy or other causes of syncope.
Treatment
1. Eliminate cough, cough suppressant can be given according to the primary disease, such as Pentoxyverine, Dioxopromethazine or Codeine. If there is phlegm, expectorant can be added, avoiding the use of centralized cough suppressant.
2. Eliminate triggering factors such as smoking, alcohol consumption, overwork, etc.
3. Special etiology treatment, such as atrioventricular block caused by the installation of pacemakers; carotid artery stenosis caused by the carotid artery stenosis should be carried out vascular bypass surgery.