Clinical spectrum of neurally mediated reflex syncopes.
OBJECTIVE
The clinical features of the various types of neurally mediated reflex syncope have not been systematically investigated and compared. We sought to assess and compare the clinical spectrum of neurally mediated reflex syncopes.


RESULTS
Four hundred sixty-one patients with syncope were prospectively evaluated and 280 had neurally mediated reflex syncope. Each patient was interviewed using a standard questionnaire. A cause of syncope was assigned using standardized diagnostic criteria. Typical vasovagal syncope was diagnosed in 39 patients, situational syncope in 34, carotid sinus syncope in 34, tilt-induced syncope in 142 and complex neurally mediated syncope (positive response to both carotid sinus massage and tilt test) in 31. The clinical features of situational, carotid sinus, tilt-induced and complex neurally mediated syncope were very similar. By contrast, typical vasovagal syncope differed from other neurally mediated syncopes not only in terms of its precipitating factors (fear, strong emotion, etc.), which constituted predefined diagnostic criteria, but also in the variety of its clinical features (lower age and prevalence of organic heart disease, higher prevalence of prodromal symptoms, and of autonomic prodromes, longer duration of prodromes, higher prevalence of symptoms during the recovery phase and lower prevalence of trauma).


CONCLUSIONS
The clinical spectrum of neurally mediated reflex syncopes demonstrates much overlap between them. However, when the afferent neural signals are localized in cortical sites, as in typical vasovagal syncope, symptoms are more frequent and of longer duration.
Alboni
Paolo
P
Division of Cardiology and Section of Arrhythmology, Ospedale Civile, 44042 Cento (Fe), Italy. p.alboni@ausl.fe.it
Brignole
Michele
M
Menozzi
Carlo
C
Raviele
Antonio
A
Del Rosso
Attilio
A
Dinelli
Maurizio
M
Bettiol
Katia
K
Bottoni
Nicola
N
Solano
Alberto
A
D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D019462:Syncope, Vasovagal / Q000145:classification / Q000175:diagnosis* / Q000503:physiopathology; D018667:Tilt-Table Test