Micturition syncope

from Wikipedia, the free encyclopedia

As micturition syncope (also pressor syncope or Postpressorische syncope ), a during urination ( urination .; Latin mingere "micturition") acute episodes of reversible loss of consciousness ( syncope ; from ancient Greek: "Colliding, discharging") denotes that a few seconds up to a maximum can take a minute.

Etiology (causes)

Micturition while standing

Micturition syncope occurs mainly in younger men during or immediately after micturition while standing. Those affected are often drowsy with an overfilled bladder, usually after consuming alcohol and immediately after getting up, typically at night ( vasodilation due to warmth of the bed). You fall suddenly or after brief, unsystematic dizziness, which can result in significant injuries. The decrease in sympathetic vasoconstrictor tone leads to a drop in blood pressure and collapse. The Valsalva mechanism at the start of micturition and the lack of support for blood pressure by the full bladder also contribute to this.

Sailors / skippers falling overboard due to urination syncope

While micturition syncope on land can lead to more or less serious fall injuries, it is known as an occasional cause of death for sailors. There are two main reasons for this:

  1. In heavy seas and cold weather, sailors are equipped with appropriate protective clothing. The urge to urinate is therefore resisted for as long as possible. If the bladder is suddenly emptied, micturition syncope can occur. If this happens at the edge of the boat, falling overboard is very likely. To make matters worse, the urinating person can only hold on with one hand and he is usually on the leeward side of the swaying ship. If the sailor is found, open trousers and possibly the exposed limb generally point to the cause.
  2. Consumption of alcohol on holiday sailing trips can provide optimal conditions for a micturition syncope and lead to the consequences already mentioned. If a crew member succumbs to urination syncope while urinating overboard, the other crew members can help under good circumstances. If the person who became briefly unconscious falls into the water, water can get into his lungs. This can lead to irritation of the respiratory tract, especially with salt water.

Other causes

  • The micturition syncope is used for difficult urination, z. B. in the context of prostatic hyperplasia , induced by a reflex increase in vagal tone (visceral reflex). It can be assigned to the clinical picture of vasovagal syncope.
  • vagotonic peripheral vasodilation
  • decreased venous return while standing
  • parasympathetic activity during micturition
  • transient cerebral ischemia

Epidemiology (spread)

Micturition syncope is relatively rare and accounts for about 5% of syncope. Polymorbid older people of both sexes are also more rarely affected.

Complications

The main complication of micturition syncope is fall-related injuries or consequences.

Symptoms

Micturition syncope may show one or more of the following symptoms:

  • Prodromi (sign): unsystematic dizziness, sweating, "turning black in front of the eyes", ringing in the ear
  • Unconsciousness lasting a few seconds up to a maximum of 1 minute
  • rapid reorientation
  • pale skin color
  • Amnesia for period of unconsciousness
  • Bradycardia and soft pulse
  • single clonic jerks possible

therapy

The therapeutic options with micturition syncope include the following:

  • Avoid triggering situation
  • Cardiovascular training
  • Compression stockings to reduce venous pooling
  • increased NaCl supply
  • possibly propranolol 3 - 4 × 10 mg / d po
  • possibly fludrocortisone

Literature and individual references

  • Heinrich Mattle, Marco Mumenthaler : Neurology . Georg Thieme Verlag, 2012, ISBN 978-3-13-157773-3 , p. 415 ( google.com [accessed August 11, 2013]).
  • C. Gleixner, M. Müller, S. Wirth: Neurology and Psychiatry. 6th edition. Medical publishing and information services, Breisach 2007, ISBN 978-3-929851-53-3 .
  • K. Poeck, W. Hacke: Neurology. 12th, updated and expanded edition. Springer Medizin Verlag, Heidelberg 2006, ISBN 3-540-29998-X .
  • H. Grehl, F. Reinhardt: Checklist neurology. 4th, revised and updated edition. Georg Thieme Verlag, Stuttgart 2008, ISBN 978-3-13-152235-1 .

Individual proof

  1. ↑ MK Lustig: Sports boat accidents: a case study. (PDF; 2.6 MB). Dissertation. University of Greifswald, 2004, p. 90.