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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

Syncope

J. Ned Pruitt II, MD

Associate Professor of Neurology

Medical College of Georgia

syncope2
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
clinical manifestations of syncope
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
causes of syncope
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
causes of syncope5
Causes of Syncope
  • Cardiovascular (cont’d)
    • Flow obstruction – pulmonary embolism, pulmonary hypertension, aortic stenosis, iodopathic hypertrophic subaortic stenosis, value disease
    • Tamponade
    • Anemia
causes of syncope6
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
causes of syncope7
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
symptoms of autonomic insufficiency
Symptoms of Autonomic Insufficiency
  • Orthostatic hypotension
    • “dizzy” with change in position
  • Dry mouth
  • Constipation or obstipation
  • Impotence
  • Blurred vision
syncope workup
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
syncope treatment
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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