일시적인 의식 소실의 임상적 유형 분석

다국어 초록 (Multilingual Abstract)

Background & objective : One of the most common but difficult management problems in medicine is patients presenting with a paroxysmal loss of consciousness (LOC). All too often the underlying diagnosis remains elusive. LOC is a common cause for emergency room visits and for hospitalization and is usually due to either seizure or syncope. However, few studies have reported on LOC in Korea. We examined the causes for LOC and its clinical characteristics.
Methods : We screened 105 patients, who experienced transient LOC without definitive convulsion, between the January 2004 and December 2009. Patients with trauma or other significant secondary causes were excluded. Data were collected on demographic characteristics, and a detailed past history and clinical information about LOC were obtained from each patient. Laboratory tests, head-up tilt test, Holter monitoring, brain magnetic resonance imaging (MRI), chest radiography, electrocardiography (ECG) and electroencephalography (EEG) were performed on all patients.
Results : Mean patient age was 40.3 ± 17.8 years, and 2.9 ± 2.4 LOC episodes occurred. The first LOC occurred at the age of 36.4 ± 18.12. The duration of LOC was short in patients with syncope, as compared to those without syncope (p = 0.008). Head-up tilt test was proven to be most informative in differentiating syncope from non-syncope etiology. Other evaluations, including Holter monitoring, brain MRI, EEG, and ECG were not helpful for the differential diagnosis. A neurocardiogenic origin was identified as the cause of LOC in the majority of cases. Other causes of LOC were orthostatic hypotension (n=8), arrhythmia (n=8), seizure (n=4), basilar artery migraine (n=1), vertebrobasilar insufficiency (n=1), hyperventilation syndrome (n=1), anaphylaxis (n=1), and psychiatric problems (n=1). The causes of LOC could not be identified in 15 patients (14.3%).
Conclusions : Neurocardiogenic syncope was the most common type in our study population. The duration of LOC and head-up tilt test were useful diagnostic parameters in differentiating syncope from non-syncope etiology in patients with LOC. However, other parameters including brain MRI and EEG were proven to have no significant value in differentiating the causes of LOC. The results for the current study suggest that, when considering cost-effectiveness, MRI and EEG should be considered only after the tests identifying variable causes of syncope have been completed or when past history and/or physical examination strongly suggest a neurologic cause of LOC.

목차 (Table of Contents)

• 1. 국문 초록 1
• 2. 서론 3
• 3. 대상과 방법 4
• 4. 결과 6
• 5. 고찰 8
• 6. 결론 12
• 7. 참고문헌 13
• 8. 영문초록 16
• 9. 부록 18