Neurological and Other Examinations

It is extremely important to complete a full peripheral and central neurological examination on all patients who present with syncope as part of a full assessment. However, a normal neurological examination does not exclude a neurological cause of loss of consciousness. For example, looking specifically for evidence of tongue injury from biting during a seizure is a clue towards possible seizure but it is an insensitive sign and its absence does not exclude seizure.

Other important points to consider on clinical assessment

1. Associated injuries caused by the collapse (think of hips in elderly patients).
2. There may be more than one cause of the collapse, particularly in elderly patients.
3. Increasing frequency of collapse is suggestive of a cardiac cause and in the presence of cardiac pathology, is an ominous sign.
4. Simple syncope during exercise is rare. The presence of exertional syncope is strongly suggestive of either an arrhythmia or a structural cardiac abnormality (eg HOCM) which warrants further urgent investigation.

Learning bite

Patients with a vasovagal syncope may have had urine incontinence and / or some convulsive type of movements