Geçici bilinç kaybıyla başvuran çocuk olguların retrospektif değerlendirilmesi

Amaç: Çalışmanın amacı, geçici bilinç kaybı (GBK) yakınması ile başvuran çocuk olguların tanılarının aydınlatılması, anamnez, etiyoloji, özgeçmiş ve soygeçmiş, fizik muayene ve laboratuvar bulgularının, tedavilerinin retrospektif değerlendirilmesidir. Yöntem: Çalışmaya Süleyman Demirel Üniversitesi Tıp Fakültesi Hastanesine GBK yakınmasıyla 1 Ağustos 2017 ile 1 Şubat 2020 tarihleri arasında çocuk polikliniklerine başvuran hastalar dahil edildi, kaydedilen anamnezleri, fizik muayene bulguları detaylı olarak geriye dönük incelendi. Yapılan biyokimyasal laboratuvar incelemeleri, elektrokardiyografi (EKG), transtorasik ekokardiyografi (EKO), 24 saatlik ritm Holter EKG, kraniyal manyetik rezonans (MR) görüntüleme, elektroensefalografi (EEG) retrospektif olarak tanıya ve tedaviye yönelik değerlendirildi. Bulgular: Hastaların 110’u (%68.8) kız, 50’si (%31.2) erkek idi. Hastaların ortalama yaşı 11.4 (±4.8) idi. Hastaların geçirdikleri ortalama GBK sayısı 1.6 (±1.2) idi. Bu çalışmadaki hastaların %33’ü tekrarlayan GBK atakları ile başvurmuştu. Bu çalışmada GBK tanısına yönelik yapılan ileri incelemelerde en sık neden vazovagal senkop (VVS) (51 hasta, %31.9), ikinci olarak epilepsi/FK/AFK (febril konvülzyon/afebril konvülzyon) (41 hasta, %25.6), üçüncü olarak psikojenik senkop (28 hasta, %17.5) olarak saptanmıştır. Diğer nedenler de sırasıyla durumsal, katılma nöbeti, OH (ortostatik hipotansiyon), migren/SVO (serebrovasküler olay), kardiyojenik, BPPV (benign paroksizmal pozisyonel vertigo) olarak bulunmuştur. Hastalara yapılan biyokimyasal tetkikler, EKG, EKO, 24 saatlik ritm Holter EKG, EEG, kraniyal MR incelemeleri analiz edildi ve değerlendirildi. Sonuç: GBK yakınmasıyla başvuran her hastadan ayrıntılı anamnez alınmalı, tam sistemik muayene yapılmalı ve EKG çekilmelidir. Kan testleri, EEG, EKO, nörogörüntüleme, 24 saatlik ritm Holter EKG değerlendirmeleri ön tanıya yönelik istenmelidir.

Anahtar Kelimeler:

Çocuk, Bilinç kaybı, Senkop, Nörolojik tanısal teknikler, Kardiyovasküler tanısal teknikler

Retrospective evaluation for pediatric patients presenting with transient loss of consciousness complaint

Objective: With this study was aimed to evaluate for pediatric patients presenting with transient loss of consciousness complaint. To document according to etiology, patients were investigated about history, physical examination, diagnostic tests and medications. Method: Children admitted to Suleyman Demirel University Faculty of Medicine with transient loss of consciousness complaint were included between August 2017 and February 2020. History of the cases, physical examination findings, the results of biochemical test-electrocardiogram (ECG) -transthoracic echocardiography- 24 hours rhythm Holter ECG monitorization-neuroimaging-electroencephalography have been recorded, after that analyzed and evaluated them retrospectively. Results: A total of 160 children with transient loss of consciousness were constituted 110 (68.8%) girls, 50 (31.2%) boys. The mean age was 11.4 (±4.8) years. The mean number of transient loss of consciousness attacks of the cases was 1.6 (± 1.2). Thirty-three percent of our total episodes were recurrent transient loss of consciousness episodes. With the further investigations in this study were found the most relevant etiology as neurocardiogenic syncope (51 patients, 31.9%), secondly epileptic seizures/febrile/afebrile convulsions (41 patients, 25.6%), thirdly psychogenic syncope (28 patients, 17.5 %). The other causes were defined that situational, breath-holding spells, orthostatic hypotension, migraine/ cerebrovascular event, cardiogenic syncope, benign paroxysmal positional vertigo. In this study were analyzed and evaluated biochemical tests, ECG, echocardiography, 24 hours rhythm Holter ECG, electroencephalography, brain magnetic resonance imaging. Conclusion: A detailed history, physical examination and ECG could be performed all patients presenting with transient loss of consciousness in children. The other further investigations would useful if definitive diagnosis is unknown via initial assessments.

Keywords:

Child, Unconsciousness, Syncope, Neurological diagnostic technic, Cardiovascular diagnostic technic,

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