Syncope in Childhood: Retrospective Analysis of 121 Cases

Aim: The aim of this study was to evaluate patients with syncope and to categorize the etiology of syncope. Material and Method: The records of 121 patients (72 girls, 49 boys; mean age: 10,5 years ±4,8) admitted to our pediatric neurology outpatient clinic between January 2012 and September 2012 were retrospectively reviewed for age, sex, number of syncopal events, diagnostic tests (laboratory, cardiac, neurophysiologic). Results: Patients with syncope constituted approximately 1,5 % of the patients admitted to our pediatric neurology out-patient clinic in nine months period. Fifty (41,3 %) cases had one syncopal event, 32 (26,3 %) cases two, 22 (18,2 %) cases three and 17 (14,1 %) cases more than three syncopal events. One hundred and ten (91 %) cases were further investigated with echocardiography, 68 (56,2 %) cases with cranial magnetic resonance imaging, 66 (54,5%) cases with electroencephalography, 20 (16,5 %) cases with Holter monitoring, and 1 case with tilt-table test. The etiology of syncope was classified as follows: 1. Syncope associated with global cerebral hypoperfusion (reflex, orthostatic hypotension, cardiac) 2. Conditions causing transient loss conciousness without global cerebral hypoperfusion (epileptic seizure, hypoglycemia, pschogenic). Syncope cases were diagnosed as reflex (neurally- mediated) (n=88), neurologic (n=11), orthostatic (n=10), pschycogenic (n=5), cardiac (n=4), metabolic (n=3). Reflex (neurally- mediated) syncope was further grouped as vasovagal (n=61), reflex-anoxic (breath holding) (n=21), situational syncope (n=6). Cardiac syncope was further grouped as arrhythmia (n=3) and structural diseases (n=1). Neurologic cases were diagnosed as epilepsy and metabolic cases were diagnosed as hypoglycemia. Discussion: In the majority of cases syncope is benign, but it can sometimes be a clinical manifestation of cardiac, neurological, or metabolic diseases. Together with a detailed history and physical examination an electrocardiogram must complete the initial evaluation of all patients with syncope. Further investigations are needed in necessary cases