Diagnostic criteria for vasovagal syncope based on a quantitative history

Sheldon, Robert S.; Rose, Sarah; Connolly, Stuart J.; Ritchie, Debbie; Koshman, Mary Lou; Frenneaux, Michael

doi:10.1093/eurheartj/ehi584

Cited by 224 publications

(175 citation statements)

References 23 publications

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“…Guidelines now exist that use clinical history alone to distinguish NCS from seizures (94% sensitivity and specificity; Figure 3) or other forms of syncope (89% sensitivity and 91% specificity). 11,12 Despite this, NCS is still commonly mistaken for epileptic seizures even though the conditions rarely coexist in the same patient. 18 Neurocardiogenic syncope is estimated to constitute 6% to 39% of cases of presumed epilepsy depending on the population studied 19 and therefore erroneous diagnosis may lead to inappropriate treatment with social and economic stigmatization.…”

Section: Discussionmentioning

confidence: 99%

Neurocardiogenic Syncope: Frequency and Consequences of its Misdiagnosis as Epilepsy

Josephson

Rahey

Sadler

2007

Can. j. neurol. sci.

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Neurocardiogenic (vasovagal/vasodepressor) syncope (NCS) is a reflex mediated loss of consciousness resulting from the failure of the autonomic nervous system to maintain adequate cerebral perfusion pressure. 1,2 Excessive peripheral venous pooling of blood in combination with aberrant responses of mechanoreceptors to compensatory cardiac hypercontractility results in a paradoxical reflex bradycardia and drop in peripheral vascular resistance. 3,4 The consequent cerebral hypoperfusion induces a transient loss of consciousness that is associated with abnormal movements (e.g. myoclonic jerks) in 12-90% of patients. 2,[5][6][7][8][9][10] Despite clinical guidelines that distinguish NCS ABSTRACT: Background: Neurocardiogenic syncope (NCS) can be mistaken as a seizure. We reviewed the frequency and diagnostic consequences of this misdiagnosis. Methods: A retrospective review of outpatient adult epilepsy clinic charts (QEII Health Sciences Centre, Halifax, NS) was conducted to identify NCS patients referred with a provisional diagnosis of seizures. Charts were reviewed in detail with an emphasis on the consequences of misdiagnosis. Results: Of 1506 consecutive referrals to the epilepsy clinic, 194 (12.9%) ultimately had a clinical diagnosis of NCS. Mean age was 38 +/-16 years (mean age of syncopal onset was 28 +/-16 years). Two-thirds of referrals were from primary care physicians (including emergency departments) and 18% from neurologists. Thirty-five percent were prescribed antiepileptic drugs (AEDs) prior to referral with eight patients (4.1%) experiencing hypersensitivity reactions. Three of five women had adverse pregnancy outcomes while taking AEDs. One-third of patients had restrictions placed on their driving privileges while 11 patients (5.7%) had their employment interrupted. Diagnostic modalities used in the work-up included EEG (90%), CT head (51%), and MRI head (15%). Conclusions: NCS is commonly misdiagnosed as epilepsy. Some patients had an incorrect diagnosis for > 10 years. Patients with this misdiagnosis are often excessively investigated, inappropriately treated, and have unnecessary restrictions placed on driving and employment. RÉSUMÉ: Syncope neurocardiogénique : fréquence et conséquences d'un diagnostic erroné d'épilepsie.Contexte : Une syncope neurocardiogénique (SNC) peut être prise à tort pour une crise convulsive. Nous revoyons la fréquence et les conséquences d'un tel diagnostic erroné. Méthodes : Nous avons effectué une révision rétrospective des dossiers de patients de la clinique externe d'épilepsie (QEII Health Sciences Centre, Halifax, NS) afin d'identifier les patients ayant présenté une SNC qui y ont été référés avec un diagnostic provisoire de crise convulsive. Les dossiers ont été révisés en détail, particulièrement en ce qui concerne les conséquences d'un diagnostic erroné. Résultats : On a posé ultérieurement un diagnostic de SNC chez 194 (12,9%) de 1506 patients consécutifs référés à la clinique d'épilepsie. L'âge moyen des patients était de 38 ± 16 ans et l'âge moyen au moment ...

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Section: Discussionmentioning

confidence: 99%

Neurocardiogenic Syncope: Frequency and Consequences of its Misdiagnosis as Epilepsy

Josephson

Rahey

Sadler

2007

Can. j. neurol. sci.

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“…Clinical history should particularly include questions regarding the occurrence and the duration of prodromal signs, the circumstances of a syncopal episode, the number and the duration of syncopal episodes and potential symptoms occurring after regaining consciousness [8,9].…”

Section: Discussionmentioning

confidence: 99%

The Clinical Course of Presyncope in the Differential Diagnosis of Syncope

Stryjewski¹,

Kuczaj

Braczkowski

et al. 2015

Ross. kardiol. ž.

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Syncope is a transient loss of consciousness caused by transient, general cerebral hypoperfusion, characterized by rapid onset, short duration and spontaneous recovery [1,2].The most frequent type of syncope is reflex syncope (neurally-mediated syncope), among which vasovagal syncope is the most frequent type [3].Vasovagal syncope, which constitutes up to 40% of syncope of unclear origin, is defined as a rapid loss of consciousness due to excessive reaction of the autonomic nervous system [1,4].During syncope a rapid decrease in systolic blood pressure occurs and, in consequence, a significant decrease in cerebral blood flow is noted [1,5].Cardiac syncope constitutes the second most prevalent type of syncope. The main reasons of cardiogenic syncope are rhythm disturbances such as supraventricular and ventricular tachycardia and bradyarrhytmia (as a combination of sinus node dysfunction, atrioventricular node dysfunction and malfunction of implantable devices). They lead to hemodynamic instability, which may cause a critical decrease in cardiac output and in cerebral blood flow [1,2].Determining the cause of syncope is a significant part of syncope evaluation. In the current ESC guidelines for the diagnosis and management of syncope two aspects of patients with syncope were stressed. These are the determination of the exact cause of syncope in order to imple- Aim. To evaluate the clinical signs and symptoms in the differential diagnosis of syncope. Material and methods. We investigated 160 patients (64 men and 96 women), aged 18-77 years with reflex or cardiac syncope over the last 3 years. The following were investigated: age, sex, age at first syncope, number of presyncopal episodes, number of syncopal episodes, number of sudden syncope without prodromal signs and the circumstances of syncope. Moreover, we assessed the frequencies of prodromal signs in the differential diagnosis of syncope. Results. Patients with reflex syncope were younger compared to patients with cardiac syncope (41,3±16,5 vs. 61,8±12,8; P<0,001) and had lower weight and body mass index (BMI). Reflex syncope patients more often presented with presyncope (10 (2, 20) vs. 2 (1, 3); p=0,01)) and syncope (8,1±7,8 vs. 5,4±1,6; P<0,001). Dyspnea, heart palpitations, feeling of cold or heat, visual disturbances and tinnitus were associated with reflex syncope (P<0,01). КЛИНИЧЕСКОЕ ТЕЧЕНИЕ СИНКОПЕ В ДИФФЕРЕНЦИАЛЬНОЙ ДИАГНОСТИКЕ СИНКОПАЛЬНЫХ СОСТОЯНИЙ Conclusion.The course of syncope may facilitate a diagnostic process of reflex and cardiac syncope.

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“…Los ojos suelen estar abiertos, como en el síncope, pero tienden a desviar la mirada hacia un lado. La mordedura lateral de la lengua 12 . la desviación cefálica 8 y la emisión de un grito al inicio del episodio son otros datos a favor de que estamos ante una crisis epiléptica.…”

Section: Discussionunclassified

Monitorización con vídeo-EEG y ECG simultáneo para el diagnóstico diferencial de trastornos de conciencia transitorios: A propósito de un caso

Carmona-Iragui

Gómez‐Ibáñez²,

Carmona-Abellán

et al. 2012

Anales Sis San Navarra

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REsuMEnSe presenta el caso de una mujer de 36 años, con antecedentes de trastornos de conciencia transitorios con cortejo vegetativo en la adolescencia, interpretados como crisis epilépticas y tratados con ácido valproico durante dos años. Tras permanecer nueve años asintomática, reaparecieron asociados a migraña, vómi-tos y alguna convulsión generalizada. El electroencefalograma y la resonancia magnética cerebral resultaron normales e inició tratamiento con zonisamida, sin beneficio. Estudios cardiológicos posteriores objetivaron bloqueo de rama izquierda, que coincidía con mareo. Se completó el estudio mediante monitorización con vídeo-EEG, donde tuvo un episodio que evidenció actividad epileptiforme temporal derecha, estableciéndose el diagnóstico de epilepsia focal de causa desconocida. Actualmente, permanece asintomática con oxcarbacepina. La anamnesis es fundamental para diferenciar trastornos de conciencia transitorios, especialmente sínco-pes y crisis epilépticas, pero no siempre es suficiente. La monitorización con vídeo-EEG y registro simultáneo de electrocardiograma resulta muy útil para distinguirlos.Palabras clave. Trastorno de conciencia transitorio. Crisis epiléptica. Síncope. Monitorización vídeo-EEG. ECG. aBstRactWe present the case of a 36 year-old woman, with history of transient consciousness disorders with vegetative state, interpreted as epileptic seizures and treated with valproic acid for two years. After nine asymptomatic years, they reappeared associated with migraine, vomiting and some generalized convulsions. Electroencephalogram and cerebral magnetic resonance turned out normal, and treatment with zonisamide was started, without beneficial results. Later cardiological studies objectified a blockage of the left branch that coincided with dizziness. The study was completed with Video-EEG monitoring, where there was an episode that showed right temporal epileptiform activity, with a diagnosis established of focal epilepsy of unknown etiology. At present, she remains asymptomatic with oxycarbazepine.

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Diagnostic criteria for vasovagal syncope based on a quantitative history

Abstract: A simple point score of historical features distinguishes vasovagal syncope from syncope of other causes with very high sensitivity and specificity.

Cited by 224 publications

References 23 publications

Neurocardiogenic Syncope: Frequency and Consequences of its Misdiagnosis as Epilepsy

Neurocardiogenic Syncope: Frequency and Consequences of its Misdiagnosis as Epilepsy

The Clinical Course of Presyncope in the Differential Diagnosis of Syncope

Monitorización con vídeo-EEG y ECG simultáneo para el diagnóstico diferencial de trastornos de conciencia transitorios: A propósito de un caso

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