실신을 주소로 방문한 소아의 원인질환에 대한 임상적 고찰

Abstract

Objectives: Syncope is a common symptom, with 15% to 25% of children and adolescents experiencing at least one syncopal episode by young adulthood. In most cases, syncope is a symptom of benign diseases but may be a symptom of severe cardiac disease that result in sudden death. The diagnostic approach of syncope is important and difficult, nevertheless various tests have been done, a cause of syncope is not diagnosed in 40% to 50%. The purpose of this study is to analyze the etiologies and clinical characteristics of syncope in children and adolescents.

Methods: Among the children who visited the Department of Pediatrics at Chosun University Hospital from February 2007 to March 2013, we retroprospectively analyzed 51 patients with syncope. We reported age in which syncope occurred, duration and state of syncope, associated symptoms, laboratory tests, head-up tilt test, 24hr Holter monitoring, electrocardiography, echocardiography, electroencephalography and brain MRI.

Results: 51 patients were included in the study and the rate of males to female was 1: 1.04. Mean patient age was 12.7± 3.1 years. Mean frequency of syncopal episodes at visit was 1.7 ± 1.8. Abrupt standing was the most common state of patients with syncopal attack. The etiologies of syncope were noncardiac syncope (60.7%), cardiac syncope (2%), neuropsychiatric syncope (25.5%), and unknown (11.8%). We recommended taking medications to 27 patients, but 24 patients accepted. The medications were alpha agonist, beta antagonist or anticonvulsants. Abnormality of head-up tilt test was more common on noncardiac syncope than remainders [ 38.7% (12/31) vs 5% (1/20) (p=0.007)]. And EEG is useful diagnostic test on neuropychiatric syncope[ 41.6% (5/12) vs 2.7% (1/36) (p=0.002)]. However, other parameters were proven to have no significant value in differentiating the etiology of syncope.

Conclusion: Noncardiac syncope is the most common type in our study population. Detailed history taking and physical examinations were useful tools to diagnose the etiology of sycope. Head-up tilt test is an effective diagnostic test in noncardiac syncope and EEG is a valuable test in neuropychiatric syncope, especially in seizure.