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Chiropractic Journal of Australia : CJA March 2012
25 Chiropractic Journal of Australia Volume 42 Number 1 March 2012 INTRODUCTION This report describes a case of a 22 month old female with medically diagnosed neurogenic syncope, whose episodes signifcantly reduced immediately after chiropractic care. A review of the literature did not produce any previous published case reports regarding reduction of syncope episodes in a paediatric patient as a result of chiropractic care. Published articles relating to paediatric syncope are reviewed, and guidelines are suggested which may assist the chiropractor when managing a child with syncope. Syncope can be defined as “a temporary loss of consciousness and postural tone secondary to a lack of adequate cerebral blood perfusion.” 1 Neurogenic syncope (also know as refex syncope and vaso-vagal syncope), is believed to occur due to a combination of peripheral arterial and venous vasodilation, followed closely by a relative bradycardia.1 This results in the typical loss of consciousness. Other types of syncope include postural orthostatic tachycardia syndrome (POTS),2 orthostatic intolerance, apneic syncope (breath holding spells, fainting larks), and pathological syncope.3 Chiropractic Management of a 22 Month Old Child with Syncope: A Case Report and Suggested Management within the Chiropractic Clinic ADAM STEWART ABSTRACT: Objective: i To present a case report which describes a reduction in the clinical episodes of neuro- genic (vaso-vagal) syncope in a 22 month old female under chiropractic management, and to provide the reader with information to assist in management of paediatric syncope in the chiropractic clinic. Clinical Features: A 22 month old female presented for assessment regarding recurrent, spontaneous loss of consciousness occurring since 16 months age. Thorough medical testing had revealed no pathology, and a presumptive di- agnosis of neurogenic (vaso-vagal) syncope had been made. On examination an upper cervical subluxation was diagnosed using defned and reproducible criteria. Intervention and Outcome: A specifc chiropractic adjustment was applied, resulting in an immediate reduction in the number of the syncopic episodes. A later relapse occurred, with repeated adjustment, leading to continued reduction in the number of episodes. Conclusions: Chiropractic management resulted in a reduction in the frequency of syncope episodes in a 22 month female. Further studies are required to elucidate possible mechanisms for the resolution in this case. Clinical management strategies are discussed to assist the chiropractor with clinical decision making in the child with syncope. INDEX TERMS: (MESH): CHIROPRACTIC; PEDIATRICS; SYNCOPE. (OTHER): NEUROGENIC SYNCOPE; VASOVAGAL SYNCOPE. Chiropr J Aust 2012; 42: 25-30. Adam Stewart, B.App.Sci (Chiro) B.App.Sci (Clinical). Private Practice Monbulk Victoria Confict of Interest Statement: There is no confict Received: 10 January 2012. Accepted with revisions: 24 January 2012 Few studies have examined the incidence of paediatric syncope. In 1989, a population based study found an incidence of 126/100,000 for a fve year period (1987-1991).4 The mean age of presentation for females and males was 16 and 13 years respectively. The incidence peaked in the 15- 19 year old range. A more recent study5 looked at records of 156 (mean age 10) children presenting to the emergency department over a two year period, fnding an incidence of 86.5/100,000 per year. Up to 15% of children will experience at least one episode before the age of 8-18, with syncope being unusual in those under 6, unless in patients with seizure disorders, breath holding, and primary cardiac dysrhythmias.6 In 70% of adult patients, syncope occurs as an isolated episode.7 No data was found on recurrence of syncope in children. Several studies have looked at the various causes of syncope in children. The vaso-vagal type is most common (range 50-80%), and pathological causes are less common (range 2-10%). These are summarized in Table 1. CASE REPORT MC, a 22 month old female, presented with her mother, with episodes of “black-outs” occurring since 16 months of age. The mother was a good historian. The episodes involved sudden loss of consciousness (LOC) lasting 2-60 seconds. These episodes occurred 2-8 times a day for 4-5 days, then would be absent for 2-3 days. The cycle would then repeat. The episodes had been occurring
CJA June 2012