Abstract
Differential diagnosis of seizures and convulsive syncope may be challenging in clinical practice. Furthermore, a misleading diagnosis of epilepsy may be detrimental for the patient as it often implies an over-prescription and an over-use of antiepileptic drugs which can cause adverse reactions. Moreover, a wrong diagnosis also causes distress to the patient with the risk of performing plenty of investigations without any benefits on the symptoms.
In this case, we present a 57-year-old patient suffering from recurrent convulsive syncope over the last 7 years for which he underwent several cardiological and neurological tests and took plenty of antiepileptic drugs without any benefits on his convulsive episodes with loss of consciousness. During hospitalization, a chest X-ray was performed revealing an unknown diaphragmatic hernia with eventration of the transverse colon in the right hemitorax and mild cardiac compression. The patient underwent laparotomic surgery and diaphragmatic reconstruction with complete recovery. After 6-month follow-up, the patient no longer had episodes of convulsive syncope.
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References
Ozkara C, Metin B, Kucukoglu S (2009) Convulsive syncope: a condition to be differentiated from epilepsy. Epileptic Disord 11(4):315–319. https://doi.org/10.1684/epd.2009.0281
Oishi Y, Ishimoto T, Nagase N et al (2004) Syncope upon swallowing caused by an esophageal hiatal hernia compressing the left atrium: a case report. Echocardiography 21:61–64
Demirkan B, Guray Y, Guray U et al (2009) An unusual presentation of diaphragmatic hernia. Echocardiography 26:1107–1108
Yildiz A, Tuncez A, Demirkan B et al (2013) An unusual cause of syncope: diaphragmatic hernia. Echocardiography 30:E136–E137
Pironi D, Palazzini G, Arcieri S, Candioli S, Manigrasso A, Panarese A, Filippini A (2008) Laparoscopic diagnosis and treatment of diaphragmatic Morgagni hernia. Case report and review of the literature. Ann Ital Chir 79(1):29–36
Mohamed M, Al-Hillan A, Shah J, Zurkovsky E, Asif A, Hossain M (2020) Symptomatic congenital Morgagni hernia presenting as a chest pain: a case report. J Med Case Rep 14(1):13. https://doi.org/10.1186/s13256-019-2336-9
Harris KB, Brateanu A (2020) Recurrent syncope while eating: an unusual presentation of a diaphragmatic hernia. BMJ Case Reports CP 13:233641
Sanford Z, Weltz AS, Brown J, Shockcor N, Wu N, Park AE (2018) Morgagni hernia repair: a review. Surg Innov 25(4):389–399. https://doi.org/10.1177/1553350618777053
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Practical implication statement
To the best of our knowledge, recurrent convulsive syncope is one of the rare presentations of hernia and is very scarcely described in literature. This work supports the notion that complete investigations and alternative causes are needed to be taken into account to reach the correct diagnosis when ordinary tests are unrevealing.
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Acampora, R., Marte, G., Scala, R. et al. Recurrent convulsive syncope misdiagnosed as seizures due to a diaphragmatic hernia. Neurol Sci 42, 4727–4729 (2021). https://doi.org/10.1007/s10072-021-05410-z
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DOI: https://doi.org/10.1007/s10072-021-05410-z