Adams-Stokes syndrome (Robert Adams)
A syncope triggered by heart arrythmia. The condition is characterized by sudden transient attacks of lightheadedness or unconsciousness, with or without convulsions, due to a temporary cessation of blood supply to the brain. Caused by complete or incomplete heart block due to disturbances of the conductive path of the heart. Deep and fast respiration changes to weak and slow pulse and respiration, convulsions and respiratory pauses that may last for 60 seconds. Other symptoms may be fixed pupils, incontinence, bilateral Babinski’s sign with resumption of heart beats, and flushing of the face. Onset usually after 40 years of age. Occurs in diseases of the brain and the heart and is usually a serious symptom.
The Austrian physician Marcus Gerbezius gave the first description in 1691. According to many sources, he made the first description in 1717, but we have not been able to the bibliographiv reference for this. The next description of the phenomenon was by the Italian anatomist Giovanni Battista Morgagni (1682-1771), who described Adams-Stokes attacks in a Padua merchant. He begins his somewhat stilted description thus: " When visiting by way of consultation, I found with such a rarity of the pulse that within the 60th part of an hour the pulsastions were only 22 - and this rareness which was perpetual - was perceived to be even more considerable, as often as even two (epileptic) attacks were at hand - so that the physicians were never deceived from the increase of the rareness they foretold a paroxysm to be coming on."
The Scottish physician Thomas Spens (1764-1842) in 1792 reported a 54 year old patient which most probably suffered from the same condition. The first more scientific and systematic description was done by Robert Adams in 1827, while William Stokes, also he Irish, described it in 1854.
Gerbec reported on one of his patients: "… a melancholic, a hypochondriac, otherwise basically healthy, had such a slow pulse that the pulse of a healthy person would beat three times before his pulse would beat for a second time…he was very sluggish, frequently dizzy, and from time to time subject to mild epileptic seizures…"
- M. Gerbezius:
Pulsus mira inconstantia.
Miscellanea curiosa, sive Ephemeridum medico-physicarum Germanicum Academiae Caesareo-Leopoldinae Naturae,1691, Norimbergae, 1692, 10: 115-118. The journal title is uncertain.
First reported case of temporary cardiac arrest with syncopal attacks.
- G. B. Morgagni:
De sedibus, et causis morborum per anatomen indagatis libri quinque.
2 volums. in 1. Venetis, typ. Remondiniana 1761.
His classical descriptions of mitral stenosis and heart block in the ninth letter, volume 1, page 70. Reprinted in English translation in Willius & Keys, Cardiac Classics, 1941, pp. 177-182.
- T. Spens:
History of a case in which there took place a remarkable slowness of the pulse.
[Andrew Duncan’s] Medical and Philosophical Commentaries, Edinburgh, 1792. volume 7, pp. 458-465.
- R. Adams:
Cases of Diseases of the Heart, Accompanied with Pathological Observations.
Dublin Hospital Reports, 1827, 4: 353-453.
- W. Stokes:
Observations on some cases of permanently slow pulse.
Dublin Quarterly Journal of Medical Science, 1846, 2: 73-85.
Reprinted in Medical Classics, 1939, 3: 727-738.