Syncope

Syncope refers to rapid, transient loss of consciousness that is most commonly due to cardiovascular problems (e.g., dysrhythmias) but that may also be a reflection of autonomic disturbances. These autonomic disturbances are frequently drug induced but may include such conditions as Shy-Drager syndrome. The other major differential diagnostic concern for the neurologist is a seizure presenting as loss of consciousness. The patient's history is essential in distinguishing conditions of inadequate cerebral blood flow from seizures.

Many patients with syncope of cardiac or autonomic origin have a brief tonic spasm when they lose consciousness, and a minority have a tonic-clonic seizure. This situation appears to be more common in children and young adults, and may be exacerbated if the patient is not allowed to become recumbent during the period of hypotension. The congenital syndromes of QT interval prolongation (e.g., Romano-Ward syndrome) are frequently misdiagnosed as a primary seizure disorder instead of a cardiac arrhythmia. Analyses of patients undergoing induced ventricular fibrillation as part of a cardiac electrophysiological study reveal a high incidence of seizures in this setting.[19] EEG should be reserved for cases in which there is a reason in the history or findings on examination to suspect seizures or in which the cardiac and autonomic evaluations have not yielded a diagnosis. Other than seizures or rare autonomic neuropathies, primary neurological disorders are extremely unlikely to cause syncope.

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