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Current approaches to the clinical assessment of syncope in pediatric population

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Abstract

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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Author contributions

HP conceived the study. HP, AKB, and OP were involved in the planning, reviewing the literature, and writing of the review.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Pediatric Neurology, Faculty of Medicine, Erciyes University, 38039, Melikgazi, Kayseri, Turkey

    Ayşe Kaçar Bayram & Huseyin Per

  2. Epilepsy Center, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    Ayşe Kaçar Bayram

  3. Department of Pediatrics, Division of Pediatric Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey

    Ozge Pamukcu

Authors
  1. Ayşe Kaçar Bayram
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  2. Ozge Pamukcu
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  3. Huseyin Per
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Correspondence to Huseyin Per.

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The authors declared no potential conflicts of interest with respect to research, authorship, and/or publication of this article.

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Highlight

Syncope is one of the most common clinical problem in children. It can occur with many different etiologies. Cardiac causes of syncope in children are rare but can be life threatening. The differential diagnosis between epileptic seizures and syncope is very important. We present current approaches to the clinical assessment of syncope in pediatric population.

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Bayram, A.K., Pamukcu, O. & Per, H. Current approaches to the clinical assessment of syncope in pediatric population. Childs Nerv Syst 32, 427–436 (2016). https://doi.org/10.1007/s00381-015-2988-8

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