Classification, Diagnosis, and Treatment of Syncope

The classification, diagnosis, investigation, and management of syncopal attacks in childhood are reviewed by investigators from the Department of Cardiology, Royal Hospital for Sick Children, Glasgow, Scotland. The causes of childhood syncope are classified into 3 groups: neurally-mediated, cardiovascular, and noncardiovascular pseudo-syncope. Neurally-mediated (neurocardiogenic) syncopes are most commonly reflex in type and consist of a transient disturbance in the autonomic control of heart rate and blood pressure. They occur at any age, but most commonly in toddlers and in children between 9 and 14 years of age. Characteristically, the child is either sitting or standing, and suffers dizziness, nausea, and pallor, followed by loss of tone and consciousness. Hypotension and/or bradycardia result in cerebral hypoxia and, when severe, an anoxic seizure and incontinence. The reflex anoxic seizure resembles a pallid breath-holding attack in a toddler and consists of opisthotonus and twitching. Unlike an epileptiform discharge, the electroencephalographic (EEG) record is flat during a reflex anoxic …