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Cited by 25Cardiovascular Syncope and Autonomic DisordersVestibular and auditory disordersNeurological Complications and Syndromes

Syncope causes transient focal neurological symptoms

Ryan, D.J., Harbison, J.A., Meaney, J.F., Rice, C.P., King-Kallimanis, B., Kenny, R.A.·2015·QJM
DOI 10.1093/qjmed/hcv005
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Abstract

AIMS: The prevalence of focal neurology (FN) as a consequence of syncope is unknown. The aim of the study was to determine its prevalence, risk factors and short-term consequences. METHODS: A consecutive sample of syncope-unit attendees during a 9-month period had detailed diagnostic syncope evaluation as per European Cardiac Society guidelines coupled with assessment for FN present during syncope/pre-syncope by screening questionnaire, follow-up interview and neuroimaging (1.5T magnetic resonance imaging [MRI]). All participants were followed up for 24 months. Risk factors for FN were identified by comparing FN cases with syncope controls without FN (3:1 ratio). RESULTS: Five-hundred and forty consecutively attended for investigation of syncope (n = 401) and pre-syncope (n = 139). Thirty-one (5.7%) had FN events during hypotensive symptoms, mean age 49 years (19-85). The majority of FN cases had vasovagal syncope (VVS); 22 (71%), whereas eight had OH (25.8%) and one (3.2%) had cardiac arrhythmia. Median duration of FN was 15 min (IQR: 34.5). MRI in 28 (90%) was normal and in 3, old cerebral infarction was evident. Risk factors for FN/syncope were frequent syncope (P = 0·008), childhood syncope (P < 0.0005) and delayed diastolic recovery during active stand (P = 0·02). During 24-month follow-up and targeted intervention, no patients developed recurrence of FN. CONCLUSION: One in 20 patients with syncope/pre-syncope have co-extant FN, which during 24-month follow-up, does not progress to a persistent deficit (>24 h). Awareness of co-occurrence of FN and syncope is important as stroke misdiagnosis results in aggressive anti-hypertensive management and future events may ensue.

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Crossref · 10.1093/qjmed/hcv005

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  • Misdiagnosis of hypotensive TIA may lead to lowering of blood pressure with antihypertensive medications and to a further increase of the risk of syncope and neurologic events.

    “their misdiagnosis is particularly important because they may lead to a lowering of BP with antihypertensive medications (e.g. if focal neurology is mistakenly attributed to vascular pathology rather than hypotension), and to a further increase of the risk of syncope and neurologic events. 386”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [386]

  • These neurological events occur in only 6% of patients with recurrent syncope.

    “Although these neurological events occur in only 6% of patients with recurrent syncope”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [386]

  • Focal neurological events can occasionally occur due to hypotension and syncope, even in patients without significant carotid artery stenosis, so-called hypotensive TIA.

    “Focal neurological events can occasionally occur due to hypotension and syncope, even in patients without significant carotid artery stenosis (so called ' hypotensive TIA ').”

    From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [386]

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Authors
Ryan, D. J., Harbison, J. A., Meaney, J. F., Rice, C. P., King-Kallimanis, B., & Kenny, R. A.
Affiliations
  • Trinity College Dublin (IE)
  • St. James's Hospital (IE)
ORCID
Venue
QJM
Publisher
Oxford University Press (OUP)
Published
2015-01-27
Volume
108
Issue
9
Pages
711-718
ISSN
  • 0033-5622 (ISSN-L)
  • 1460-2725
  • 1460-2393
DOI
10.1093/qjmed/hcv005
OpenAlex
W2171880893
Cited by
25
References
32
Citations by year
2025: 1 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 5 · 2018: 5 · 2017: 2 · 2016: 3 · 2015: 2
FWCI
4.04
Type
journal article
Language
en
Open access
closed
Locations
  • QJM (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (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, focal neurological symptoms, vasovagal syncope, orthostatic hypotension, presyncope, risk factors, stroke misdiagnosis, cerebral infarction, prevalence, follow-up outcomes
MeSH terms
Adolescent, Adult, Aged, Aged, 80 and over, Ischemic Attack, Transient, Diagnosis, Differential, Diagnostic Errors, Female, Humans, Male, Middle Aged, Nervous System Diseases, Prospective Studies, Syncope, Stroke, Young Adult

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