Kostantinos Vardakas       MD, PhD

Internal Medicine Specialist

Doctorate at Infectious Diseases, University of Crete

School of Medicine

 

 Office Hours

Mon - Fri,

5pm - 9pm

Mr Kostantinos Vardakas accepts patients by appointment

 

 

A patient with complete loss of consciousness (syncope)


An 82 year old lady with a history of osteoporosis, gastro-esophageal reflux disease, back pain, bilateral hip arthroplasty, hyperlipidemia and 2 hospitalizations for pneumonia in the previous 2 years, asked for our help after an episode of "dizziness" while she was in her bathroom during urination a few hours after midnight. The patient denied the presence of any other symptoms besides mild nausea and eructation (belching) which lasted for a long time and had not changed at all in recent days. After clarifying questions, the patient revealed that she remembered entering the bathroom but not leaving it. Her husband noticed that she heard a noise and found his wife lying on the hallway between the bathroom and the bedroom and that she was unconscious. The patient reported that during the last few days she felt weak and fatigued, which forced her to significantly reduce her daily exercise.


On clinical examination, there was a recent trauma on her head, but the patient could not remember a blow in any of the preceding hours or days, suggesting complete loss of consciousness. Neurologic examination did not show anything abnormal, the heart and lungs examination as well as the electrocardiogram were normal. On the examination of her abdomen there was a cylindrical tender mass at lower left abdomen with concomitant strong sensitivity surrounding it. Although the appearance of symptoms during urination in elderly patients indicates a vasovagal reflex (vagotony, i.e. activation of a nerve that increases the bowel and urinary tract activity and significantly reduces heart function that may cause dizziness or even loss of consciousness), the presence of head trauma and the sensitivity of the abdomen required neurosurgical evaluation and further investigation and monitoring. Hospitalization was recommended.


Computed tomography of the skull and brain revealed findings according to age of the patient. The blood tests showed increased white blood cells with neutrophilia, increased C reactive protein and erythrocyte sedimentation rate (all indicating the presence of inflammation). Urinalysis showed many white blood cells and the culture grew Escherichia coli (E. coli, UTI). Blood cultures were also positive for E. coli. The CT of abdomen showed diverticulitis (infection of the bowel wall) and consolidations at the lower sections of the right lung (pneumonia). In the early hours of hospitalization and for 2 days she developed low grade fever. The patient received a combination of intravenous antibiotics. After a few days the patient had begun to slowly regain her strength, remained afebrile and was discharged from hospital after completing 14 days of intravenous antibiotics because of the presence of the E. coli in her blood (bacteremia) and abdomen. In review after a few days the patient reported that she had fully recovered.


In this case it is difficult to distinguish if syncope was due to vagotony or if it was a result of infection in three organs of her body (lungs, kidneys, intestine) that gradually aggravated her symptoms of weakness. The presence of the virus in the blood can explain how the bacteria (in this case E. coli, a bacterium which colonizes the human gut) was transferred to three different points, a situation rare in patients with an intact immune system.

 

 

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Palaio Phaliro, 17563
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