1. Dr M.Jalali neurologist
syncope
Dr M.Jalali
neurologist

2. Rapid onset Short duration Spontaneous complete recovery
Transient loss of con ciousness due to transient global cerebral hypoperfusion characterized by:
Rapid onset
Short duration
Spontaneous complete recovery

3. Conditions incorrectly diagnosed as syncope:
Disorders with partial or complete LOC but without cerebral hypoperfusion:
Epilepsy
metabolic disorders including hypoglycemia, hypocapnia
Intoxication
Vertebrobasilar TIA
Disorders without impairment of conciousness
Drop attack
psychogenic

4. Classification of syncope
-reflex(neurally mediated) syncope -orthostatic hypotention mediated syncope -cardiac syncope

5. Reflex syncope(neurally mediated syncope):
-Vasovagal:
Mediated by emotional:fear,pain,blood phobia
Mediated by orthostatic stress
-Situational:
Cough ,valsava,micturation
-Carotid sinus syncope

6. Syncope due to orthostatic hypotension:
Primary autonomic failure:PD,lewy body dementia
Secondary autonomic failure:DM,amyloidosis,spinal cord injury
Drug induced:vasodilator
Volume depletion:hemorrhage,diarrhea

7. Cardiac syncope -Arrhythmia
-Structural disease:pulmonary emboli,valvular heart disease,cardiac mass,tamponade,aortic dissection,MI

8. Careful hx Physical exam (orthostatic hypotension) ECG
Initial evaluation of a patient presenting with transient loss of conciousness:
Careful hx
Physical exam (orthostatic hypotension)
ECG

9. Initial evaluation should answer three key questions:
Is it a syncopal episode or not?
Has the etiological diagnosis been determined?
Are there data suggestive of a high risk of cardiovascular events or death?

10. history
Position:supine,sitting,standing Activity:rest,exercise,cough,micturtion,swallowing Predisposing factor:prolonged standing,hot weather Stimulating factors:fear,severe pain,neck movement Symptoms prior syncope:N/V,dizziness,sweating,aura,blurred vision Attack:skin color,LOC duration ,respiration,abnormal movement,tongue bitting,urinary incontinency post attack myalgia and headache,injury Medical history:medication,heart dx,DM,family hx of sudden death

11. Clinical clue Reflex syncope:
After pain or fear,prolonged standing,N/V,after eating,pressure on carotid,hot weather
during or after micturation,cough,defication,swallowing
Orthostatic hypotension:
Postural change,hx of autonomic neuropathy or parkinsonism,anti hypertensive drugs
Cardiac syncope:
heart dx,palpitation,sudden death family hx,supine position,on exercise
Situational

12. Differentiation between syncope and convulsion
Seizure
syncope
Relation to posture no
common
Time of day
diurnal or nocturnal
diurnal
Aura or premonitory symptoms
brief
long
Convulsion
rare
injury
urinary incontinency
Tongue biting
Postictal confusion
Postictal headache
Focal neurological signs
Cardiovascular signs