The etiology of syncope varies by age and may be due to circulatory, cardiac, metabolic, neurologic, situational, or even psychiatric processes. 2 As many as 30% to 50% of children will have had at least one syncopal episode by the time they reach 18 years of age. 1 Girls are impacted more often than boys. It is a common presenting complaint in pediatric emergency departments (ED) that accounts for as many as 3% of all ED visits in children. Syncope is an abrupt, transient loss of consciousness due to decreased blood pressure and cerebral blood flow. The remainder of her exam is grossly normal. Gait not examined per patient’s request as she was worried about precipitating a syncopal episode.
#CONVULSIVE SYNCOPAL EPISODE FULL#
She is alert and oriented x 4, pupils are equal, round, and reactive to light, cranial nerves 2─12 are intact, full strength in all four extremities. Regular rate and rhythm without murmurs, rubs, or gallops, 2+ radial and femoral pulses, cap refill <2 seconds. The patient is overall well-appearing, sitting up in the exam bed on her phone. She denies chest pain, palpitations, difficulty breathing, phonophobia, or photophobia. With a repeat episode, mom brought her to urgent care for further evaluation. Earlier this week, she was diagnosed with vasovagal syncope and instructed to increase fluid and electrolyte intake and to follow up with her primary care physician. She has also had intermittent frontal headaches for the last 4 days and left sided tinnitus for the last 3-4 months. She states that she has only had one bottle of water in the last 24 hours. The episodes do not appear to be related to exercise. She reports feeling dizzy when this happens.
Each episode has occurred when she stands up from a sitting or supine position and lasts a few seconds. Nehal Bhandari, MD, FAAP and Abbas Zaidi, MD, FAAP CASE PRESENTATIONĪ 12-year-old previously healthy female presents to urgent care with several episodes of “blacking out” over the past 4 days. As such, it is essential to keep a broad differential and to eliminate potentially life-threatening etiologies. Urgent message: Syncope in pediatric patients may be attributed to a wide variety of sources.
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