Case report

A 21-year-old woman presented with recurrent blackouts from the age of 9 years, which occurred either during or immediately after urination. Because all episodes occurred in the toilet, there was no witness account. She noticed that she could prevent the episodes by contracting her pelvic floor while urinating, giving a slow and interrupted urine stream. She would delay visiting the toilet for as long as possible, and avoid using public lavatories. Bowel opening did not trigger the episodes. She also had episodes of nocturnal enuresis. There was no family history of bladder troubles or neurological disease. She had been born at term following a normal delivery and had normal psychomotor development.

EEG recordings, each lasting 30 min, at ages 12 years, 16 years and 18 years were normal. She had two normal ECGs at the ages of 16 years and 18 years. CT and MR scans of brain were normal.

She was referred to the uro-neurology department for her ‘bladder problem’. Neurological and urological examinations were normal. Suspecting a seizure phenomenon, she underwent video-EEG telemetry when aged 18 years. The EEG was normal and there were no events during this test, despite her passing urine five times. There was a short period of tachycardia when her pulse reached 156 beats per minute. For the few months following the EEG, she had hardly any blackouts.

Urodynamic studies to evaluate her nocturnal enuresis found …