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Current approaches to the clinical assessment of syncope in pediatric population
Ayşe Kaçar Bayram1,2, Ozge Pamukcu3, Huseyin Per4
1Department of Pediatrics, Division of Pediatric Neurology, Faculty of Medicine, Erciyes University, 38039, Melikgazi, Kayseri, Turkey. draysebayram@gmail.com.
Insights
Pediatric syncope, a common cause of transient loss of consciousness, requires careful diagnosis. This review outlines practical approaches for evaluating syncope in children, distinguishing it from seizures.
Area of Science:
- Pediatric Neurology
- Cardiology
- Clinical Medicine
Background:
- Syncope is a frequent clinical issue in children, marked by temporary, self-resolving loss of consciousness due to reduced brain blood flow.
- While often benign, syncope can be alarming for families and requires thorough evaluation due to diverse pediatric etiologies.
Purpose of the Study:
- To present diverse syncope types in children.
- To offer updated, practical clinical strategies for diagnosing, investigating, and managing pediatric syncope.
Main Methods:
- Categorization of syncope into neurally mediated, cardiovascular-mediated, and non-cardiovascular types.
- Emphasis on detailed history and physical examination due to asymptomatic presentation.
- Highlighting the importance of differentiating syncope from epileptic seizures.
Main Results:
- Cardiac causes of pediatric syncope, though rare, carry significant morbidity and mortality risks.
- Misdiagnosis of epilepsy is a common challenge in syncope evaluation.
- Diagnostic workup for syncope in children can be costly with limited diagnostic yield.
Conclusions:
- Accurate diagnosis and management of pediatric syncope are crucial.
- Clinical assessment should focus on identifying triggers and differentiating from seizures.
- A systematic approach is needed for effective pediatric syncope care.
Introduction:
Syncope is one of the most common clinical problem in children. This disorder is characterized by transient, spontaneously self-terminating loss of consciousness with brief duration and complete recovery. This situation is usually alarming for the families of patients. The mechanism of syncope is transient global brain hypoperfusion to levels below those tolerated by cerebrovascular autoregulation. Syncope can occur with many different etiologies in the pediatric population.
Classification:
Syncopes are divided into three major categories as neurally mediated syncope, cardiovascular-mediated syncope, and non-cardiovascular syncope.
Clinical Features:
The major challenge in the assessment of children with syncope is that most children are asymptomatic at the time of their presentation, therefore making a careful and detailed history and a comprehensive physical examination essential in all patients. A trigger stimulus is detected in some cases, and this is an important clinical clue for the diagnosis. Cardiac causes of syncope in children are rare but can be life threatening and have the highest risk of morbidity and mortality. Misdiagnosis of epilepsy is common in patients presenting with syncope; therefore, the differential diagnosis between epileptic seizures and syncope is very important. It should be remembered that the evaluation of syncope in children is costly and diagnostic workup has a limited diagnostic yield.
Conclusion:
The aim of this article is to present different types of syncope and to provide new practical clinical approaches to the diagnosis, investigation, and management in the pediatric population.
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