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 should be differentiated from other conditions causing partial or complete loss of consciousness. These disorders may include, coma, dizziness, seizure, and vertigo. There are conditions that may mistakenly be diagnosed as syncope. These conditions include epilepsy, hypoglycemia, intoxication, cataplexy, and transient ischemic attacks.

Differentiating Syncope from other Diseases

Syncope should be differentiated from other conditions causing partial or loss of consciousness. These disorders may include:

• Coma
• Dizziness
• Seizure
• Shock
• Vertigo

Conditions Incorrectly Diagnosed as Syncope
Disorders with partial or complete loss of consciousness
Epilepsy
Metabolic disorders: Hypoglycemia Hypoxia Hyperventilation with hypocapnia
Intoxication
Vertebrobasilar TIA
Conditions without loss of consciousness
Cataplexy
Falls
Functional (pseudoscope)
Drop attacks
TIA of carotid origin

The above table adopted from ESC guideline

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
Wernicke’s encephalopathy	History of alcohol abuse	–	+	–	–	–	+	+	+	+	–	NA	Clinical assesment and lab findings	Ophthalmoplegia Confusion
Drug toxicity	Medication history of Lithium Sedatives Phenytoin Carbamazepine	–	+	–	+	+	+	–	+	–	–	NA	Drug screen test	Confusion
Metabolic disturbances (electrolyte imbalance, hypoglycemia)	–	–	+	+	+	+	+	–	–	+	–	Hypoglycemia, hyponatremia, hypernatremia, hypokalemia, and hyperkalemia	Depends on the cause	Confusion Seizure Palpitation Sweating Dizziness Hypoglycemia
Meningitis or encephalitis	History of fever and malaise	+	–	–	–	–	+	+	–	–	–	↑ Leukocytes, ↑ protein, ↓ glucose	CSF analysis	Fever Neck rigidity Confusion

References

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