Stokes-Adams attack
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The term Stokes-Adams Attack refers to a sudden, transient episode of syncope, occasionally featuring seizures. It is named after two Irish physicians, Robert Adams (1791–1875) and William Stokes (1804–1877).
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[edit] Signs and symptoms
The patient goes pale just before the attack, the pulse stops, and they collapse. Normal periods of unconsciousness are around 30 seconds; if seizures are present, they will consist of twitching after 15–20 seconds. Breathing continues normally throughout the attack, and so on recovery the patient becomes flushed as the heart rapidly pumps the oxygenated blood from the pulmonary beds into a systemic circulation which has become dilated due to hypoxia.
As with any syncopal episode that results from a cardiac dysrhythmia, the faints do not depend on the patient's position. If they occur during sleep, the presenting symptom may simply be feeling hot and flushed on waking.
[edit] Diagnosis
Stokes-Adams attacks may be diagnosed from the history, with paleness prior to the attack and flushing after it particularly characteristic. The ECG will show asystole or ventricular fibrillation during the attacks.
[edit] Causes
The attacks are caused by loss of cardiac output due to cardiac asystole, heart block, or ventricular fibrillation. The resulting lack of blood flow to the brain is responsible for the faint.
[edit] Treatment
Treatment is normally surgical, involving the insertion of a pacemaker.
[edit] Prognosis
If undiagnosed (or untreated), Stokes-Adams attacks have a 50% mortality within a year of the first episode. The prognosis following treatment is very good.
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