Fourteen cases of transient aphasia induced by head-up tilt test

Objective To explore the clinical characteristics and the possible pathogenesis for transient aphasia induced by head-up tilt test(HUTT). Methods The data of 4 401 cases(aged from 2 to 79 years) were reviewed retrospectively with unexplained syncope, pre-syncope, or dizziness who had visited syncope specialists at out-patient department or had been hospitalized in the Second Xiangya Hospital of Central South University, and they underwent HUTT from Sep.2000 to Apr.2014.The clinical characteristics were summarized and the possible pathogenesis for transient aphasia was analyzed. Results (1)The total incidence of aphasia was 3.18‰(14/4 401 cases). The incidence in adult(≥18 years old) was significantly higher than that in children( 0.05]. According to the hemodynamic changes, the incidences in vasodepressor, the mixed type, cardioinhibition and the negative response were 6.05‰(10/1 654 cases), 4.18‰(2/479 cases), 0(0/36 cases) and 0.9‰(2/2 232 cases) respectively, and the differences among the 4 groups were significant(χ2=8.22, P<0.05); the difference existed between the vasodepressor and the negative response(χ2=8.18, P<0.01). The total incidence of the positive response patients was 5.53‰(12/2 169 cases), and the difference was notable compared with the negative response patients (χ2=6.07, P<0.05). (2)The onset time and the duration time of transient aphasia: the onset time was from 4 to 17 minutes during baseline head-up tilt test, mean (11.3±6.7) minutes, or 2-10 minutes during sublingual nitroglycerin-provocated head-up tilt test, mean (5.2±2.7) minutes.Aphasia duration was from 3 minutes to 4 hours, and the median time was 20 minutes. Conclusions There is a risk of provoking transient aphasia during HUTT, which reminds that the performer should alert possible occurrence of this complication during the test, especially when the patient has a positive response, or is an adult. Key words: Head-up tilt test; Transient aphasia; Clinical characteristic