Syncope is the sudden loss of consciousness. When we evaluate the patient for syncope, typically we try to break it down into two categories: cardiogenic or neurogenic. Cardiogenic syncope is preceded by lightheadedness, chest pain, palpitation, shortness of breath, and sweating. After the patient wakes up typically he/she are back to normal without confusion or disorientation. Neurogenic syncope is on the other hand is not preceded by symptoms or occasionally preceded by funny feeling in the stomach, odd sensation in the head, or nausea. After the patient wakes up, he/she might be confused, disoriented, with evidence of tongue biting, and loss of bladder or bowel control.
As neurologists we approach patients with syncope by first determining if it is cardiac or neurologic and do the neurologic workup. Cardiac workup is typically deferred to the cardiologist. Workup may include imaging of the brain (a CAT scan or an MRI), echocardiogram, carotid ultrasound, electroencephalogram (EEG) and/or (autonomic nervous system (ANS) testing. If there is a cardiac suspicion then we refer the patient to a cardiologist to complete the cardiac workup.
The treatment of syncope dependents on the etiology. If seizure is proven or strongly suspected, antiepileptics are initiated. If dysautonomia is suspected, we try to identify the cause and treat it. If cardiac etiology is suspected, the patient is referred to a cardiologist for treatment.