腦中風併發抽搞性昏厥之一病例報告

抽搐是腦中風常見的合併症，但並非所有的抽搐皆是由於癲癇而引起。早期正確的診斷可避兔錯誤之處理及爭取治療時效。本文提出一男性病例，係因第二次腦中風而入院。在復健治療期間屢次發生類似強直性痙攣、雙眼上視等現象，經投與抗癲癇藥物達治療濃度後仍時常發生上述症狀。因此，我們使用傾斜床站立試驗對病人加以測試。發現病人在站立一段時間後有血壓下降、心跳變慢、冒汗、打哈欠、臉色蒼白等現象，繼之發生左側肢體類似強直性痙攣並失去意識。若即時使病人平躺，則病人即能在極短時間內恢復。因此，經診斷為抽搐性昏厥。在開始復健初期，此種發作次數頻繁。經復健治療及雙足使用彈性繃帶加壓後，其發作次數明顯減少，且經較長時間才會誘發。在此提出此一病例以供大家參考。

關鍵字

癲癇；抽搐性昏厥

並列摘要

Seizure is one of the complications after cerebrovascular accidents, but not all convulsions are epilepsy. Many other diseases such as vasovagal syncope, hypoglycemia and arrhythmia may cause seizure-like episodes. So, we must identify the actual cause to prevent inappropriate treatment. We report a 69 year-old male patient who was asmitted to rehabilitation department due to recurrent cerebrovascular accident with right hemiplegia. Loss of consciousness, myoclonic rhythmic jerk of left arm, upward gazing were noted frequently in upright and sitting position. After return to the lying position, the above symptoms and signs would disappear in few seconds. Antiepileptic dru as given to him but in vain. Tilt table test was performed for this patient. Pallor face, cold sweating, decreased heart rate, decreased blood pressure were noted and followed by myoclonic rhythmic jerk of left arm, upward gazing, loss of consciousness. After tilting table training and elastic bandage usage, the episode of convulsive syncope decreased and the heart rate increased even when his blood pressure dropped. The propose of this case report is to point out (l) not all seizures are due to epilepsy. Postural hypotention may be resulted in seizure-like episodes (convulsive syncope). (2) Tilt table test is not only a tool for diagnose convulsive syncope but also a tool that can increase the tolerance of patients. Usage of elastic bandage can decrease the venous blood pooling. Combining with tilt table training and usage of elastic bandage can decrease the frequency of convulsive syncope attack.

並列關鍵字

epilepsy ； convulsive syncope

國際替代計量

腦中風併發抽搞性昏厥之一病例報告

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