Syncope in a neurological clinic

Objective — to analyze the medical histories of the neurological clinic patients who were diagnosed with syncope after excluding the diagnosis of stroke, epilepsy and cardiac pathology. Materials and methods. 112 medical histories at the Kyiv hospital neurological clinic patients with the leasing diagnosis of syncope were analyzed. These were cases in which cardiogenic syncope, strokes and epileptic seizures were excluded at the beginning of the examination. Standard examinations, neuroimaging methods, ultrasound examination of the main arteries of the head, ultrasound of the abdominal cavity and pelvis were used for diagnosis. Results and discusion. According to the etiology and pathogenesis of the onset and development, syncope states in the diagnoses were divided into vegetative dysfunction, the consequences of a closed traumatic brain injury, the consequences of a neuroinfection, congenital pathology and dyscirculatory encephalopathy. When assessing, we considered the multifactorial nature of onset and the complexity of syncope development mechanisms in patients. Among these groups of patients, vegetative and vascular mechanisms of syncope were dominant. Instability of blood pressure, asthenia with fixation on one’s own sensations, emotional lability, the presence of eyelid and finger tremor, acrohyperhidrosis and so on clinically indicated the involvement of vegetative dysfunction in the examined groups. Vegetative disorders were also quite often caused by concomitant somatic pathology and pain syndrome from cervical osteochondrosis. That is, among the neurogenic mechanisms, dyscirculatory, maladaptive, emotional, associative and somatogenic mechanisms dominated. At the same time, in groups with chronic cerebral circulatory insufficiency, symptoms from the eyes, changes in tendon reflexes, elements of ataxia and presence of diffuse metabolic changes in the heart were more frequently detected. Osteochondrosis of the cervical spine also formed elements of vascular vertebrobasilar insufficiency in such patients. The similarity of symptoms in some groups was due, among other things, to the cross-action of different mechanisms. More than half of the patients with a history of closed traumatic brain injury had previously been diagnosed with brain contusion, i. e., post-traumatic encephalopathy. Half of the patients with consequences of neuroinfecion had a concomitant diagnosis of dyscirculatory encephalopathy and almost half of the patients with the consequences of congenital pathology had perinatal encephalopathy. However, a certain difference in the frequency of symptoms among these groups was also noted, for example, the consequences of neuroinfections group was characterized by greater astheno-neurotic manifestations and inflammatory changes in the blood. Conclusions. Making a diagnosis of a syncopal state by vegetative and vascular mechanisms required the primary exclusion of the classical cardiogenic (heart attack, blockades, etc.), psychogenic (hysteria, hyperventilation syndrome), cerebral (stroke, migraine), hypoxemic and orthostatic types . Encephalopathy and osteochondrosis of the cervical spine played a significant role in dyscirculatory disorders. Among the identified neurogenic mechanisms, dyscirculatory, maladaptive, emotive, associative and somatogenic mechanisms dominated.