抄録
We encountered a patient who developed dizziness due to the vasovagal reflex (VVR) during the Schellong test (ST).
A 32-year-old woman had a chief complaint of dizziness. Present Illness: She had repeatedly since childhood experienced dizziness attacks associated with darkness in front of her eyes immediately after standing up. She easily developed motion sickness. Dizziness continued to occur when she was standing in a bus or train, when she was in the bath, or when she got excited. She was admitted to a hospital in the district and ECG and a blood test were conducted, but no abnormal findings were revealed. Past History: She had bronchial asthma in childhood. She had a gastric ulcer and received drug treatment in january 1997. Family history was unremarkable.
She had a positive Schellong test. Immediately after standing up, her pulse rate sharply increased from 94 to 123/min., and 5 min. after standing up, the pulse rate became 127/min. She complained of dizziness immediately before the end of the testing, and the pulse rate and blood pressure measured at the time were 75/min., showing a sharp decline, and 90/55, showing a slight decrease, respectively. Thereafter, she had decreased consciousness and was immediately laid in a supine position. She soon became alert. Blood pressure recovered to 106/62 and the pulse rate to 94. Neural symptoms were absent. Treatment and Clinical Course: Although she developed WR during ST, her condition could be diagnosed as orthostatic dysregulation (OD) because it met the criteria for diagnosis of OD. However, a diagnosis of postural tachycardia syndrome (POTS) was made according to the theory that WR and OD are special types of POTS. She is under medication with an α-receptor agonist agent.
Patients are always at risk, although not high, of developing VVR and falling during ST, which may be associated with injury. Therefore, after the experience of the present case in our hospital, we reevaluated the procedures of ST and decided on crite-ria for the discontinuation of the testing to prevent accidents.
