syncope workup

[CueDoc]

Do any of you include a head ct in a syncope workup if there is no head trauma resulting from the episode? if so, do you do it on everyone or only a certain age group, etc.?

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[MacGyver]

Do any of you include a head ct in a syncope workup if there is no head trauma resulting from the episode? if so, do you do it on everyone or only a certain age group, etc.?

Hell no, waste of money. Only reason its done at all is defensive medicine.

 

[southerndoc]

Hell no, waste of money. Only reason its done at all is defensive medicine.

I agree. It's unlikely that an ischemic event would cause syncope. A bleed can (i.e., SAH), but patients almost always complain of headaches. If the patient syncoped and complains of a headache, then yes, I scan. Otherwise, I don't.

 

[realruby2000]

if after they passed out and had a pretty nasty head injury, or if their hx is a little fishy, or if anything in the hx suggests SAH ( usually not ) or if it sounds like a new onset seizure then yes, i've seen these patients get scanned.

 

[The White Coat Investor]

If I can't decide if it was syncope or seizure I may lean toward a scan.

 

[WilcoWorld]

I never CT for isolsated syncope with return to normal mental status. If there was head trauma, persisting AMS, if I can't do a neuro exam, or if the syncope was really a seizure then I'll do the CT. In order to loose consciousness from a CNS etiology one must loose function of both cerebral hemispheres or the entire reticular activating system. In both cases that ptient will not return to a normal mental status.

But as I type the above dogma I find myself wondering why I feel compelled to do a complete neuro exam on each syncope patient. Is it just chart dressing?

 

[roja]

No. CT head is not indicated in a pure syncope work up.


A neuor exam is important. Because if it is focal, you need to scan them.

For a good, overall article on syncope:

http://www.emedicine.com/emerg/topic876.htm