Related Experiment Videos
Syncope in childhood
M L McHarg1, S Shinnar, H Rascoff
1Department of Neurology, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
Insights
Evaluating pediatric syncope is crucial, as a quarter of cases reveal serious, treatable conditions like migraines, seizures, or cardiac arrhythmias, not just vasovagal syncope.
Area of Science:
- Pediatric Neurology
- Pediatric Cardiology
- Clinical Medicine
Background:
- Syncope in children presents a diagnostic challenge.
- Distinguishing vasovagal syncope from other causes is difficult.
- Referrals for syncope evaluation are common in pediatric clinics.
Purpose of the Study:
- To determine the incidence of various etiologies in pediatric syncope.
- To identify clinical features that differentiate syncope causes in children.
- To emphasize the importance of actively seeking serious disorders in pediatric syncope.
Main Methods:
- Retrospective and prospective review of 108 pediatric patients (ages 2-19) evaluated for syncope.
- Defined syncope as transient loss of consciousness with undetermined etiology at presentation.
- Correlated medical history, family history, clinical features, and diagnostic tests with final diagnoses over a mean 2.0-year follow-up.
Main Results:
- An etiology for syncope was identified in 27% of cases.
- Identified etiologies included migraines (11%), seizures (8%), and cardiac arrhythmias (6%).
- No specific clinical or historical features reliably distinguished vasovagal syncope from other causes.
Conclusions:
- Pediatric syncope evaluations frequently uncover serious, treatable conditions beyond vasovagal syncope.
- Active investigation for underlying disorders like migraines, seizures, and cardiac issues is essential.
- Clinical and historical data alone are insufficient to reliably differentiate pediatric syncope etiologies.
Abstract:
The records of 108 children, ages 2 to 19 years (mean age 11.3 years), who were referred to the pediatric neurology and pediatric cardiology clinics for syncope, were reviewed. Sixty-six cases were identified retrospectively, and 42 prospectively. Syncope was defined as transient and complete loss of consciousness with no etiology determined at the time of presentation. The mean follow-up was 2.0 years. In 27 cases (25%), an etiology for syncope was found, including migraines in 12 cases (11%), seizures in 9 cases (8%), and cardiac arrhythmias in 6 cases (6%). All other cases were classified as vasovagal (neurocardiogenic). The past medical history, family history, clinical features of each syncopal episode, and diagnostic tests of each subject were correlated to final diagnosis. No clinical or historical features reliably distinguished children with vasovagal syncope from those with other etiologies. Children referred for the evaluation of syncope have a significant incidence of serious but treatable disorders, which should be actively sought.