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Syncope J. Ned Pruitt II, MD Associate Professor of Neurology Medical College of Georgia Syncope Syncope – a transient loss of consciousness with a loss of postural tone caused by a brief global reduction or cessation of cerebral blood flow

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Syncope

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Syncope

J. Ned Pruitt II, MD

Associate Professor of Neurology

Medical College of Georgia


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Syncope

  • 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


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Clinical Manifestations of Syncope

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

  • Rostral to caudal progression

  • Myoclonus – “jerking” not seizure activity

  • Rapid recovery of consciousness without a post-ictal confusion or exhaustion

  • No focal neurologic before or after event


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Causes 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


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Causes of Syncope

  • Cardiovascular (cont’d)

    • Flow obstruction – pulmonary embolism, pulmonary hypertension, aortic stenosis, iodopathic hypertrophic subaortic stenosis, value disease

    • Tamponade

    • Anemia


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Causes 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


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Causes 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


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Symptoms of Autonomic Insufficiency

  • Orthostatic hypotension

    • “dizzy” with change in position

  • Dry mouth

  • Constipation or obstipation

  • Impotence

  • Blurred vision


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Syncope Workup

  • History and physical

  • BP in both arms

  • BP lying, sitting and standing

  • ECG, cardiac event monitor or loop recorder

  • Rarely EEG

  • MRI and CT of little use if neuro exam is normal


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Syncope Treatment

  • Cardiac – pacemaker, medications if low CO, defibrillator

  • Removal of offending medications

  • Treatment of vascular disease

  • Counciling and recognition – paperbag

  • Autonomic insufficiency – SSRI, NaCl, midodrine,


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