Clinical Characteristics Of Children Syncope And Follow-up Study

Objective: In order to improve the diagnosis and treatment,we analyzed theetiology and clinical features of syncope in children.Methods: In120cases of children with the chief complain of " syncope " in theFirst Affiliated Hospital of Dalian Medical University pediatric outpatient andhospitalization from January2002to January2012, and we followed up part of them byclinic or telephone.Result: In120children cases with the chief complain of “syncope”,106cases werediagnosed syncope,14cases who were similar syncope were misdiagnosed assyncope.There were87the autonomic nerve-mediated syncope(AMS) cases in106syncope cases, accounting for82.1%, including54vasovagal syncope cases,30posturalorthostatic tachycardia cases,2situational syncope cases（1micturition syncope case,1acute bleeding syncope case）,1orthostatic hypotension case. There were3cardiogenicsyncope cases, accounting for2.8%;1syncope cases was caused by cerebrovasculardisease, accounting for0.9%,;15unexplained syncope cases, accounting for14.2%.14cases who were similar syncope included5cases with metabolic diseases (3casesdue to diabetic hypoglycemia,2cases due to electrolyte imbalance),5cases werecaused by nervous system diseases,2cases caused by epileptic seizures,1case cerebralhemorrhage,1case caused by viral encephalitis,1cases caused by vertigo of vestibular,1anemia case caused by menorrhagia;3cases caused by mental illness.Age and sex characters:The children of syncope which were caused bycardiogenic, neurogenic and metabolic diseases were younger than the children ofmediated by the autonomic nervous and mental disease.There were more girls in theautonomic nervous system mediated syncope and neurological diseases caused bysimilar syncope.Inducement: In87AMS cases, the most common inducement was prolonged standing, then was nerve stimulation. Movement or crying were the commoninducement in cardiac syncope. In5cases of metabolic diseases,1case was caused byinjected overdose insulin,2cases was caused by without eating in time after injection,2cases were caused by water and electrolyte disturbance after diarrhea. Mentalstimulation was the inducement in the children who were caused by mental illness.Aura symptoms:69cases had dizziness, blackouts, and pale, chest tightness,nausea, sweating and other symptoms in87AMS cases.3similar syncope cases causedby metabolic diseases (hypoglycemia) in children, they had weakness, sweating,pale, dizziness and other aura symptoms before they fainted. There was no obvious aurasymptom in3cardiac syncope cases.Onset of postural characteristics：79AMS cases(90.8%) happened when theywere standing；Children with unexplained syncope (13cases, accounting for76.5%)also occurred when they were standing. Other types occured syncope in variouspositions.Past history and family history characteristics：3cases of cardiac syncope hadsignificant history of heart diseases; There was a history of recurrent syncope in AMS,cardiac syncope, similar syncope caused by mental disorders; Part of the AMS patients(17cases, accounting for19.5%) and syncope cases caused by neurological diseases(2cases,66.7%) had significant family history of syncope. Cardiac syncope inchildren (1case, accounting for33.3%) had the family history of sudden death.Assistant examination: The ECG of3cardiac syncope cases was abnormal.56children were inspected with EEG.15cases were abnormal, including4abnormal EEGcases who were neurogenic syncope(2cases found epilepsy wave,2cases found widerange of slow-wave), other11children showed varying degrees of slow wave. Inneurogenic syncope,1cerebral hemorrhage was diagnosed by brain CT and MRI,1viralencephalitis by cerebrospinal fluid examination,1vestibular vertigo was diagnosed byvestibular function test.Head-up tilt test,HUTT:71cases were inspected by HUTT in120patients,accounting for59.2%.54cases were confirmed as vasovagal syncope,including12angiostatin cases,10cardioinhibitory type cases,32mixed cases. There was oneorthostatic hypotension (OH),16cases of the postural orthostatic tachycardia syndrome(POTS).The follow-up results:21cases were followed. We followed up12cases of vasovagalsyncope in children, including six boys and six girls. Follow-up time differ from3 months to6years. More than half can avoided syncope after health education andphysical therapy in11cases of vasovagal syncope. There was no complications when85%children attacked by syncope who were unable to avoid syncope. Two cardiacsyncope children were followed up from1month to1year, one patient died and theother case hasn’t attack by syncope for1year after installed cardiac pacemaker. Onesimilar syncope patient caused by electrolyte imbalance didn’t attack by syncope in3months. We followed up six unexplained syncope cases in children from6months to3years, including4cases with frequent episodes which three cases were diagnosedvasovagal syncope by HUTT.Conclusion:1There are many reasons in the etiology of syncope in children, the most commonreason is the syncope mediated by autonomic nervous system and the majority isvasovagal syncope.2. History collection and physical examination are the basis for diagnosis ofsyncope and it is important for differential diagnosis select assistant examination.3.Every type syncope varies in clinical features and identifying these clinicalfeatures has an important significance for improving the efficiency of diagnosis ofsyncope in children.4. syncope is a benign disease, most of these patients can reduce syncoperecurrence and the attack degree through health education and physical therapy.