Syncope: how the EEG helps in understanding clinical findings

Although it is now widely accepted that the key to accurate diagnosis and risk stratification of syncope is a thoughtful and scrupulous history, exactly what is meant by the history remains unclear, and moving it from experts to front-line workers has proven difficult. Partly this is because syncope is simply a symptom, like fever, with a plethora of potential causes. Partly as well this reflects the multitude of somewhat overlapping symptoms and signs for the most common form, the ‘faint’ or vasovagal syncope. There are several clinical features that are known to be helpful in the differential diagnosis of loss of consciousnesses, based on quantitative symptom studies. These for example help distinguish epileptic convulsions and pseudosyncope from syncope, but such studies were aimed at clinical decision-making. They reported just the most highly significant clinical points and do not help clinicians make sense of the welter of symptoms that clinical experience suggests (Sheldon et al. , 2002, 2006; Wieling et al. , 2009; Tannemaat et al. , 2013).In this issue of Brain , van Dijk et al. (2014) provide fascinating and informative insights into why some symptoms cluster with each other in patients with vasovagal syncope. The authors …