静脈穿刺で発現した血管迷走神経反射性失神の1例

A Case of Vasovagal Syncope Associated with Venipuncture

　患者は33歳男性．静脈穿刺をするたびに失神発作があり，痙攣を伴うこともあった．また，精神的緊張でも意識消失することがあった．痙攣発作が疑われ神経内科に入院．静脈穿刺による痙攣発作誘発中15秒以上の心停止が確認された．今まで数度の失神発作の既往があり，失神発作の予知，予防は困難と考えDDDペースメーカーを植込んだ．血管迷走神経反射性失神の治療は確立していない．しかし，今後失神発作を繰り返し心抑制がある血管迷走神経反射性失神には，DDDペースメーカーが治療の中心となると思われた．

A 33 year-old-man presented recurrent syncopal episodes after venipuncture. This was sometimes as-sociated with seizure. It was also noted that the syncope was aroused by mental stress. The patient was admitted to the department of neurogical medicine because of epilepsy. Cardiac arrest of more than 15 seconds was detected during the venipuncture-prooshed syncope test. He had normal routine testing, holter monitering, head CT scan, carotid sinus massage, val-salva maneuver etc. The syncope was similar to a malignant vasovagal one which has no typical warning signs. He had recurrent syncopal episodes without typical prodrome.