[Neurological and psychiatric assessment of syncope]

A transient loss of consciousness (TLOC) may have different causes. The term syncope is restricted to an underlying sudden decrease in cerebral perfusion. In most cases, syncopes or other causes of TLOC are recognizable by a basic diagnostic evaluation (history taking, physical examination, ECG, and supine and upright blood pressure measurements). Cues for epileptic seizures, e.g., delayed recovery, should prompt an extended search for an epileptic focus. Unusual features of the attacks without any hint for a syncopal or an epileptic origin require the psychiatric inspection of suspected dissociative (psychogenic) seizures. Neurogenic orthostatic hypotension results from sympathetic failure. The underlying disease (Parkinson's disease, pure autonomic failure, autonomic neuropathy, etc.) has to be identified by neurological examinations.