Abstract
Objective: Although neurocardiogenic syncope is the most common type of syncope in children, a wide variety of neurologic and cardiologic disorders may present with syncope. However, the diagnostic yield for most tests commonly used in the evaluation of children with syncope is low. We aimed to document the clinical characteristics, etiology, and the value of neurologic and cardiologic investigations in the diagnosis of syncope in children.
Material and Methods: Hospital charts of 241 children (169 female and 72 male) who were referred to the pediatric neurology department due to syncope between July 2011 and December 2013 were retrospectively reviewed. Outcome variables were etiology and yield of diagnostic tests performed.
Results: The etiology was neurocardiogenic syncope in 146 (60.6%), postural ortostatic tachycardia syndrome (POTS) in 30 (12.4%), epilepsy in 22 (9.1%), cardiac causes in 6 (2.5%), psychogenic pseudosyncope in 23 (9.5%), reflex syncope in 4 (1.7%), unspecified syncope in 9 (3.7%) patients and hydrocephalus in 1 (0.4%) patient. Electroencephalography was performed in 157 (65.1%) patients and revealed epileptic discharges in 25 (15.8%) of them. Neuroimaging studies were performed in 95 (39.4%) patients and revealed incidental white-matter lesions in 12 (13%) patients and mesial temporal sclerosis and aqueductus Sylvii stenosis in 1 patient (%1.1) each. Electrocardiography was performed in all patients and revealed complete atrioventricular block in 3 (1.3%) patients and 2nd degree atrio-ventricular block (Mobitz type II) and short PR interval with a delta wave in 1 (0.4%) patient each. Echocardiography was performed in all patients and revealed mitral valve prolapsus in 11 (4.6%), mitral regurgitation in 3 (1.2%) patients and severe aortic stenosis in 1 patient (0.4%). Tilt testing was performed in 93 (38.6%) patients and revealed POTS in 34 (36.5%) and vasodepressor response in 14 (15.0%) patients. The Holter test was performed in 21 (8.7%) patients and was abnormal in 1 (4.7%) of them. Anemia, hypoglycemia or electrolyte imbalance was not found to be the cause of syncope in any of the patients.
Conclusion: A wide variety of neurologic or cardiac disorders can present with syncope in children. A focused history and a thorough clinical examination along with electrocardiography can reveal the cause of syncope in the majority of cases. The yield of electroencephalography, neuroimaging, echocardiography, tilt test, Holter test, and routine blood tests is very low
Keywords: Child, Cardiac syncope, Neurocardiogenic syncope
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