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患者は35歳男性.自宅で意識消失発作.頭痛や嘔気を訴えず,来院時は昏迷状態で項部硬直はなく神経学的所見に異常はなかった.心電図では脈拍40/分で洞機能不全状態,心室性補充調律,高度房室ブロックを認め,硫酸アトロピンの静注にて洞性調律に復した.その後頭痛と嘔吐,痙攣とともに再び意識消失発作が出現,CTと血管造影にてbasilar topの動脈瘤破裂によるクモ膜下出血と診断された.
クモ膜下出血の際には多彩な心電図異常がみられるが,多くは交感神経系の活動性亢進に基づくものが多い.本症例では発症直後に生じた一過性の副交感神経系刺激が証明され,クモ膜下出血と心電図異常を論じるうえで興味深い1例と考えられる.
A 35-year-old man was hospitalized after a sudden onset of transient syncopal attack without accompan-ing complaints of headache or nausea. He was slightly disorientated but neurologically normal. He had a blood pressure of 150/90mmHg and a pulse rate of 40/min. An ECG showed marked sinus brady-cardia with ventricular escaped rhythm followed by advanced atrioventricular (AV) block. Some components of con-ducted ventricular beats showed aberration. There was no significant ST or T wave abnormality in normally captured QRS components except for prominent T in leads Ⅱ, Ⅲ and aVF.
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