Le perdite transitorie di coscienza solo apparenti: affezioni che il cardiologo non dovrebbe ignorare

Le perdite transitorie di coscienza solo apparenti: affezioni che il cardiologo non dovrebbe ignorare, Elisa Favaron (Unità di Riabilitazione Psichiatrica e delle Dipendenze, Villa Silvia, Senigallia), Paolo Alboni (Sezione di Cardiologia e Syncope Unit, Ospedale Privato Quisisana, Ferrara).

Affections such as psychogenic (functional) pseudosyncope and cataplexy are characterized by transient attackswithout impairment of consciousness, but with loss of postural control and unresponsiveness. Therefore, these disorders should be differentiated from syncope and should not be ignored by the cardiologist, whois usually a reference point for patients with syncope or suspected syncope. Clinical findings that suggestpsychogenic pseudosyncope include frequent attacks always in the presence of audience, a fall to the groundthat may develop slowly enough to allow the patient to stagger and break the fall before hitting the floor,prolonged attacks (>10 min), many psychosomatic symptoms as the clinical context.

In most cases, the differentialdiagnosis should be made with neurally mediated syncope; to this end, tilt test appears to be veryuseful. Cataplexy is a relevant symptom of narcolepsy; the differential diagnosis between cataplexy and syncopeshould be made only when symptoms of narcolepsy are mild. Clinical findings that suggest cataplexyinclude an emotional trigger – above all if the emotion is positive –, an “unreal” fall similar to that observedin patients with psychogenic pseudosyncope, repeated attacks in a daytime, symptoms of narcolepsy as theclinical context. Since cataleptic attacks are triggered by emotion, in most cases the differential diagnosisshould be made with vasovagal syncope; a positive emotion as a trigger suggests a cataleptic attack.

Key words: Cataplexy; Narcolepsy; Psychogenic pseudosyncope; Syncope.