SyncopeSyncope

J. Ned Pruitt II, MD

Associate Professor of Neurology

Medical College of Georgia

SyncopeSyncope

Syncope – a transient loss of consciousness with a loss of postural tone caused by a brief global reduction or cessation of cerebral blood flow – Causes - cardiac, neurlogic, vascular, and

psychiatric

Clinical Manifestations of Clinical Manifestations of SyncopeSyncope

“Dizzyness” or dysequilibrium – visual changes “greying out” - mental clouding – deafness – nausea – loss of postural tone

Rostral to caudal progression Myoclonus – “jerking” not seizure activityRapid recovery of consciousness without a

post-ictal confusion or exhaustionNo focal neurologic before or after event

Causes of SyncopeCauses of Syncope

Cardiovascular – – Decreased preload – hypovolemia/hemorrhage,

Valsalva manuever– Decreased iontrophy – cardiac ischemia,

cardiomyopathy– Dysrhythmia -

Bradycardia - asystole, carotid sinus hypersensitivity, micturtion, defecation

Tachycardia - supraventricular or ventricular

Causes of SyncopeCauses of Syncope

Cardiovascular (cont’d)– Flow obstruction – pulmonary embolism,

pulmonary hypertension, aortic stenosis, iodopathic hypertrophic subaortic stenosis, value disease

– Tamponade– Anemia

Causes of SyncopeCauses of Syncope

Neurologic– Neurocardiogenic sycope – “the faint”

Vasovagal syncope

– Autonomic insufficency Medications – alpha and beta blockers Peripheral neuropathy – diabetes, GBS Adrenal insufficiency Prolonged bedrest syrinx

Causes of SyncopeCauses of Syncope

Neurologic - (cont’d)– Increased intracranial pressure – SAH, shunt

malfunction, obstructive hydrocephalus, venous sinus occlusion

– Vertebral artery disease – dissection with embolus, subclavian steal

– Hyperventilation

Symptoms of Autonomic Symptoms of Autonomic InsufficiencyInsufficiency

Orthostatic hypotension– “dizzy” with change in position

Dry mouthConstipation or obstipationImpotenceBlurred vision

Syncope WorkupSyncope Workup

History and physicalBP in both armsBP lying, sitting and standingECG, cardiac event monitor or loop

recorderRarely EEGMRI and CT of little use if neuro exam is

normal

Syncope TreatmentSyncope Treatment

Cardiac – pacemaker, medications if low CO, defibrillator

Removal of offending medicationsTreatment of vascular diseaseCounciling and recognition – paperbagAutonomic insufficiency – SSRI, NaCl,

midodrine,