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Cited by 265Cardiovascular Syncope and Autonomic DisordersVestibular and auditory disordersNeurological Complications and Syndromes

Symptoms and signs of syncope: a review of the link between physiology and clinical clues

Wieling, W., Thijs, R. D., van Dijk, N., Wilde, A. A. M., Benditt, D. G., van Dijk, J. G.·2009·Brain
DOI 10.1093/brain/awp179
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Abstract

Detailed history taking is of paramount importance to establish a reliable diagnosis in patients with transient loss of consciousness. In this article the clinical symptoms and signs of the successive phases of a syncopal episode are reviewed. A failure of the systemic circulation to perfuse the brain sufficiently results in a stereotyped progression of neurological symptoms and signs culminating in loss of consciousness; when transient, this is syncope. Prior to loss of consciousness the affected individual tends to exhibit unclear thinking, followed by fixation of the eyes in the midline and a 'frozen' appearance. Narrowing of the field of vision with loss of colour vision ('greying' out) and finally a complete loss of vision (hence 'blacking' out) occurs. Hearing loss may occur following loss of vision. This process may take as little as approximately 7 s in cases of sudden complete circulatory arrest (e.g. abrupt asystole), but in other circumstances it may take longer depending on the rate and depth of cerebral hypoperfusion. Complete loss of consciousness occurs with the 'turning up' of the eyeballs. Profound cerebral hypoperfusion may be accompanied by myoclonic jerks.

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Crossref · 10.1093/brain/awp179

Cites

113 of 113 references verified0 citation errors · 0 not checkable

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  • A sudden cessation of cerebral blood flow for as short as 6-8 s can cause complete LOC.

    “A sudden cessation of cerebral blood flow for as short as 6-8 s can cause complete LOC.”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [8]

  • Situational reflex syncope is highly probable if syncope occurs during or immediately after specific triggers, listed in Table 3.

    “Situational reflex syncope is highly probable if syncope occurs during or immediately after specific triggers, listed in Table 3 . 8, 13-17”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [8]

  • A systolic BP of 50-60 mmHg at heart level (30-45 mmHg at brain level in the upright position) will cause LOC.

    “A systolic BP of 50-60 mmHg at heart level, i.e. 30-45 mmHg at brain level in the upright position, will cause LOC. 8,9”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [8]

  • VVS is highly probable if syncope is precipitated by pain, fear, or standing, and is associated with typical progressive prodrome (pallor, sweating, and/or nausea).

    “VVS is highly probable if syncope is precipitated by pain, fear, or standing, and is associated with typical progressive prodrome (pallor, sweating, and/or nausea). 8,13-17”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [8]

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Authors
Wieling, W., Thijs, R. D., van Dijk, N., Wilde, A. A. M., Benditt, D. G., & van Dijk, J. G.
Affiliations
  • Amsterdam UMC Location University of Amsterdam (NL)
  • Leiden University Medical Center (NL)
  • University of Minnesota (US)
ORCID
Venue
Brain
Publisher
Oxford University Press (OUP)
Published
2009-07-08
Volume
132
Issue
10
Pages
2630-2642
ISSN
  • 0006-8950 (ISSN-L)
  • 1460-2156
DOI
10.1093/brain/awp179
OpenAlex
W2116837687
Cited by
265
References
113
Citations by year
2026: 11 · 2025: 10 · 2024: 14 · 2023: 20 · 2022: 15 · 2021: 20 · 2020: 23 · 2019: 14 · 2018: 26 · 2017: 19 · 2016: 11 · 2015: 17 · 2014: 22 · 2013: 13 · 2012: 12
FWCI
1.54
Type
journal article
Language
en
Open access
closed
Locations
  • Brain (publishedVersion)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
  • Pure Amsterdam UMC (submittedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
  • Health Sciences › Medicine › Psychiatry and Mental health › Neurological Complications and Syndromes
Keywords
syncope, transient loss of consciousness, cerebral hypoperfusion, clinical symptoms and signs, hearing loss, asystole, myoclonic jerks, medical history, syncope diagnosis
MeSH terms
Acceleration, Hypoxia, Apnea, Consciousness, Electroencephalography, Flushing, Humans, Hypotension, Orthostatic, Neck, Reflex, Seizures, Syncope, Syncope, Vasovagal

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