title: Syncope causes transient focal neurological symptoms.
abstract: OBJECTIVE
  The prevalence of focal neurology (FN) as a consequence of syncope is unknown. The aim of the study was to determine its prevalence, risk factors and short-term consequences.
  
  
  METHODS
  A consecutive sample of syncope-unit attendees during a 9-month period had detailed diagnostic syncope evaluation as per European Cardiac Society guidelines coupled with assessment for FN present during syncope/pre-syncope by screening questionnaire, follow-up interview and neuroimaging (1.5T magnetic resonance imaging [MRI]). All participants were followed up for 24 months. Risk factors for FN were identified by comparing FN cases with syncope controls without FN (3:1 ratio).
  
  
  RESULTS
  Five-hundred and forty consecutively attended for investigation of syncope (n = 401) and pre-syncope (n = 139). Thirty-one (5.7%) had FN events during hypotensive symptoms, mean age 49 years (19-85). The majority of FN cases had vasovagal syncope (VVS); 22 (71%), whereas eight had OH (25.8%) and one (3.2%) had cardiac arrhythmia. Median duration of FN was 15 min (IQR: 34.5). MRI in 28 (90%) was normal and in 3, old cerebral infarction was evident. Risk factors for FN/syncope were frequent syncope (P = 0·008), childhood syncope (P < 0.0005) and delayed diastolic recovery during active stand (P = 0·02). During 24-month follow-up and targeted intervention, no patients developed recurrence of FN.
  
  
  CONCLUSIONS
  One in 20 patients with syncope/pre-syncope have co-extant FN, which during 24-month follow-up, does not progress to a persistent deficit (>24 h). Awareness of co-occurrence of FN and syncope is important as stroke misdiagnosis results in aggressive anti-hypertensive management and future events may ensue.
authors: From the Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland and d_jamesryan@yahoo.co.uk.
authors: D J
authors: DJ
authors: Ryan
authors: From the Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland and.
authors: J A
authors: JA
authors: Harbison
authors: Centre of Advanced Medical Imaging, St. James's Hospital, St. James's Street, Dublin 8, Ireland.
authors: J F
authors: JF
authors: Meaney
authors: From the Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland and.
authors: C P
authors: CP
authors: Rice
authors: From the Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland and.
authors: B
authors: B
authors: King-Kallimanis
authors: From the Trinity College Institute of Neuroscience (TCIN), Trinity College Dublin, Dublin 2, Ireland and.
authors: R A
authors: RA
authors: Kenny
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D011446:Prospective Studies; D020521:Stroke / Q000175:diagnosis; D013575:Syncope / Q000150:complications* / Q000175:diagnosis; D055815:Young Adult