Syncope differential diagnosis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Karol Gema Hernandez, M.D. [2] Sahar Memar Montazerin, M.D.[3]
Overview
Syncope's differential diagnosis can be seen in the context of transient loss of consciousness. European Task Force created an algorithm to define whether or not there has been loss of consciousness, and from there, there could be a different possible diagnoses. [1]
Differentiating Syncope from other Diseases
Similar symptoms may be seen in other diseases such as:
There are some conditions incorrectly diagnosed as syncope, which can also be differential diagnosis. Those conditions can be divided on whether to not there was loss of consciousness. The conditions with loss of consciousness but without cerebral hypoperfusion are:[1]
| Conditions Incorrectly Diagnosed as Syncope |
|---|
| Disorders with partial or complete loss of consciousness |
|
|
| Conditions without loss of consciousness |
|
|
|
| The above table adopted from ESC guideline [2] |
|---|
Syncope, must be differentiated from other diseases that may cause, altered mental status, motor and or somatosensory deficits. The table below, summarizes the neurologic differential diagnosis for syncope:
| Diseases | History | Symptoms | Physical Examination | Diagnostic tests | Other Findings | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Headache | ↓ LOC | Motor weakness | Abnormal sensory | Motor Deficit | Sensory deficit | Speech difficulty | Gait abnormality | Cranial nerves | CT/MRI | CSF | Gold standard test | |||
| Subdural hemorrhage[3][4] |
|
+ | + | + | + | + | – | – | – | + | + | Xanthochromia | CT scan without contrast | |
| Neurosyphilis | + | – | + | + | + | + | – | + | – | + | ↑ Leukocytes and protein | Specific: CSF VDRL
Sensitive: CSF FTA-Ab |
| |
| Hypertensive encephalopathy | + | + | – | – | – | – | + | + | – | + | NA | Clinical assesment |
| |
| Wernicke’s encephalopathy |
|
– | + | – | – | – | + | + | + | + | – | NA | Clinical assesment and lab findings | |
| Drug toxicity | Medication history of | – | + | – | + | + | + | – | + | – | – | NA | Drug screen test |
|
| Metabolic disturbances (electrolyte imbalance, hypoglycemia) | – | – | + | + | + | + | + | – | – | + | – | Hypoglycemia, hyponatremia, hypernatremia, hypokalemia, and hyperkalemia | Depends on the cause | |
| Meningitis or encephalitis | + | – | – | – | – | + | + | – | – | – | ↑ Leukocytes, ↑ protein, ↓ glucose | CSF analysis | ||
| Seizure |
|
+ | + | – | – | + | + | – | – | + | – | Mass lesion | Clinical assesment and EEG | |
References
- ↑ 1.0 1.1 Task Force for the Diagnosis and Management of Syncope. European Society of Cardiology (ESC). European Heart Rhythm Association (EHRA). Heart Failure Association (HFA). Heart Rhythm Society (HRS). Moya A; et al. (2009). "Guidelines for the diagnosis and management of syncope (version 2009)". Eur Heart J. 30 (21): 2631–71. doi:10.1093/eurheartj/ehp298. PMC 3295536. PMID 19713422.
- ↑ Moya, A.; Sutton, R.; Ammirati, F.; Blanc, J.-J.; Brignole, M.; Dahm, J. B.; Deharo, J.-C.; Gajek, J.; Gjesdal, K.; Krahn, A.; Massin, M.; Pepi, M.; Pezawas, T.; Granell, R. R.; Sarasin, F.; Ungar, A.; van Dijk, J. G.; Walma, E. P.; Wieling, W.; Abe, H.; Benditt, D. G.; Decker, W. W.; Grubb, B. P.; Kaufmann, H.; Morillo, C.; Olshansky, B.; Parry, S. W.; Sheldon, R.; Shen, W. K.; Vahanian, A.; Auricchio, A.; Bax, J.; Ceconi, C.; Dean, V.; Filippatos, G.; Funck-Brentano, C.; Hobbs, R.; Kearney, P.; McDonagh, T.; McGregor, K.; Popescu, B. A.; Reiner, Z.; Sechtem, U.; Sirnes, P. A.; Tendera, M.; Vardas, P.; Widimsky, P.; Auricchio, A.; Acarturk, E.; Andreotti, F.; Asteggiano, R.; Bauersfeld, U.; Bellou, A.; Benetos, A.; Brandt, J.; Chung, M. K.; Cortelli, P.; Da Costa, A.; Extramiana, F.; Ferro, J.; Gorenek, B.; Hedman, A.; Hirsch, R.; Kaliska, G.; Kenny, R. A.; Kjeldsen, K. P.; Lampert, R.; Molgard, H.; Paju, R.; Puodziukynas, A.; Raviele, A.; Roman, P.; Scherer, M.; Schondorf, R.; Sicari, R.; Vanbrabant, P.; Wolpert, C.; Zamorano, J. L. (2009). "Guidelines for the diagnosis and management of syncope (version 2009): The Task Force for the Diagnosis and Management of Syncope of the European Society of Cardiology (ESC)". European Heart Journal. 30 (21): 2631–2671. doi:10.1093/eurheartj/ehp298. ISSN 0195-668X.
- ↑ Birenbaum D, Bancroft LW, Felsberg GJ (2011). "Imaging in acute stroke". West J Emerg Med. 12 (1): 67–76. PMC 3088377. PMID 21694755.
- ↑ DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF; et al. (2011). "ACR Appropriateness Criteria® on cerebrovascular disease". J Am Coll Radiol. 8 (8): 532–8. doi:10.1016/j.jacr.2011.05.010. PMID 21807345.