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“The only difference between syncope and sudden death is that in syncope you wake up”—G L Engels
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Syncope is a common problem in adolescence, with up to one in five experiencing an episode of syncope before adulthood.2 Whereas the vast majority of syncope is benign, a minority is caused by something potentially more serious or even life threatening. For this reason and also because syncope has such a death-like quality, it often generates extreme anxiety and is often extensively, inappropriately, and unfruitfully investigated.
Classification
There are many causes of syncope and therefore it can be helpful to categorise them. One way of categorising syncope is to divide the causes into three main groups.2 Neurally mediated syncopes occur when there is a disturbance in the autonomic nervous system's control of heart rate and blood pressure. Generally they can be considered as benign. Cardiovascular causes of syncope are rare in adolescence, but it is important to be aware of them, as they are potential causes of sudden death. Non-cardiovascular syncopes can broadly be divided into the epilepsies and the psychogenic causes. In the latter the child actually fakes the syncope. It is beyond the scope of this article to discuss all the causes of syncope and the aim will be to concentrate on the most common form of syncope, the neurally mediated syncopes.
Neurally mediated syncopes
Although neurally mediated syncope can occur at any age in childhood, the peak age groups are in toddlers and in adolescents. Neurally mediated syncopes are a heterogeneous group of autonomic disorders, which result in orthostatic intolerance. Grubb suggests dividing them into four main groups: the reflex syncopes, postural orthostatic tachycardia syndrome, pure autonomic failure. and multiple system atrophy.3
Classification of syncope in adolescence
Neurally mediated syncopes
reflex syncopes
postural orthostatic tachycardia syndrome (POTS)
pure autonomic …