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[Syncope--incidence, diagnosis and differential diagnosis]
1Neurologie FMH, Inselspital, Bern.
Insights
Syncopes, or fainting spells, are common. Careful patient history and witness accounts are the most crucial diagnostic tools for identifying the cause of syncope.
Area of Science:
- Internal Medicine
- Cardiology
- Neurology
Context:
- Syncopes affect 0.75% of internal medicine outpatients and 3.6% of the general population.
- Previous studies like the Framingham study highlight the prevalence of syncopal episodes.
- Diagnosis remains challenging, with causes undetermined in 25-85% of cases despite thorough examination.
Purpose:
- To emphasize the diagnostic significance of patient history and witness accounts in syncope evaluation.
- To review the prevalence and potential causes of syncopal episodes.
- To highlight the limitations of diagnostic workups when relying solely on physical examination.
Summary:
- Syncopes are prevalent in outpatient and general populations.
- While physical examination is standard, a significant percentage of syncope cases remain undiagnosed.
- Cerebral and cardiovascular issues account for a substantial portion of diagnosed syncopes.
- Detailed patient and witness interviews are paramount for accurate syncope diagnosis.
Impact:
- Clinicians should prioritize comprehensive patient interviews and witness reports for effective syncope diagnosis.
- This approach can improve diagnostic accuracy and potentially reduce the rate of undiagnosed syncopal events.
- Highlights the need for refined diagnostic strategies focusing on subjective patient reporting.
Abstract:
Syncopes are not rare at all. They are seen in 0.75% of patients of an outpatient department of internal medicine, and 0.03% of blood donors have syncopes. In the Framingham study, in the course of 26 years 3 to 3.6% of the population had syncopes. The diagnosis can be made just by careful questioning and the usual physical examination of the patient. In spite of thorough examination, the cause of the syncope cannot be determined in 25 to 85% of cases. Among those carefully analysed, 5 to 15% are due to a primary cerebral cause and 15 bis 40% are due to a cardiovascular problem. Of course selection of patients following the institution which made these studies play an important role. We conclude that the careful questioning of the patient and, if possible, of witnesses of the syncope represents the most important element for diagnosis.