Syncope in Children –Clinico-etiological correlation

MadhuraF,Shakuntala P, SumitraV,Shilpa K

Introduction-Syncope is the abrupt cessation of cerebral blood  flow leading to temporary loss of consciousness. Identification of etiologyis utmost important as in syncopal event may be life threatening.

Aims-To correlate the clinical and etiological causes of syncope in childrenand to note their  investigational profile.

Methods –40 patients presenting with syncope and presyncope were studied.History of the event , precipitating factors were noted.They were investigated with the help of blood pressure ,Electrocardiogram(ECG), 2D Echocardiogram  and Electroencephalogram(EEG)  .

Results-Out of the 40 patients of syncope 65 %were above the age of 10 years with  malepreponderance  (60%).Vasovagal syncope(57%) was the most common cause of syncope followed by orthostatic hypotension(15%),neurological(15%),and cardiac etiology(6%).In the neurological etiology the EEG showed diffuse slow background with occasional sharp bursts in right frontal area in 2 patients while in 4 patients sharp bursts were present in the centro-temporal region. 17%were classified as presyncope,60 %as mild and 22 %as having severesyncope .There was a significant correlation of etiology of syncope with duration of hospitalisation of more than 4 days and with recurrence of syncope .There was significant correlation of Evaluation of Guidelines in Syncope (EGSYS) score >3 with cardiogenic syncope. On follow up,neurologicalsyncope patients had significant decrease in the number of syncopal episodes as they were immediately started on antiepileptics.

Conclusion- Electrocardiogram,2D Echocardiogram and  Electroencephalogram are important tools  for the  early management and treatment of cardiac and neurological etiology of syncope.