The Etiology And Clinical Features Of Unexplained Syncopy In Children

Objective:To explore the etiology, clinical features and differential diagnosis to reduce missed diagnosis and misdiagnosis.Methods:A total of 106 children with unexplained syncope in Children’s Hospital of Chongqing Medical University from January 2013 to April 2015 were enrolled. Through history, physical examination and laboratory investigation, cardiac syncope, situational syncope, drug-induced syncope, neurogenic and metabolic diseases were excluded in these patients. The etiology and clinical features were identified and compared.Results:Of 106 patients,85 (80.2%) were neurally mediated syncope (NMS),13 (12.3%) were psychogenic pseudosyncope,8 (7.5%) were unexplained syncope. Of patients with NMS,43 (39.6%) were vasovagal syncope (VVS),40 (37.7%) with postural tachycardia syndrome (POTS), 2(1.9%) with orthostatic hypertension (OHT). The common features of NMS, psychogenic pseudosyncope and unexplained syncope were at school age, mostly female, often with triggers, recurrent, major in day time, onset in four seasons and rarely in winter. Psychogenic pseudosyncope was often accompanied with psychological stimulations, less presyncopy symptoms, high frequency of syncope, high 01 grades, lasting longer (more than 10 minutes). The features of unexplained syncope were similar with NMS, mainly caused by long time standing, exercising and body position changing.Presyncopy symptoms commonly had lightheadedness, blurred vision, gastrointestinal symptoms, which were usually less than 5 minutes.Conclusions:NMS is the most common causes of syncope in children with manifested clinical signs and symptoms. Psychogenic pseudosyncope should be differentiated with NMS. The clinical features of unexplained syncope were similar with NMS.