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A guide to disorders causing transient loss of consciousness: focus on syncope

Nature Reviews Neurology volume 5, pages 438–448 (2009)Cite this article

Abstract

Episodes of transient loss of consciousness (TLOC) events pose diagnostic difficulties, as the causes are diverse, carry vastly different risks, and span various specialties. An inconsistent terminology contributes to the confusion. Here, we present a classification scheme for TLOC, based on ongoing multidisciplinary efforts including those of the Task Force on Syncope of the European Society of Cardiology. We also discuss the pathophysiology of TLOC and the key clinical features that aid diagnosis. TLOC is defined as an apparent loss of consciousness with an abrupt onset, a short duration, and a spontaneous and complete recovery. Syncope is defined as TLOC due to cerebral hypoperfusion, and is divided into reflex syncope (synonymous with neurally mediated syncope), syncope due to orthostatic hypotension, and cardiac syncope (arrhythmic or associated with structural cardiac disease). The other major groups of TLOC are generalized epileptic seizures, functional TLOC (psychogenic TLOC mimicking either epilepsy or syncope), and a further group of miscellaneous disorders. The management of patients who experience TLOC requires the recognition of the defining features of each of the major groups, and cooperation between different clinical specialties.

Key Points

  • Transient loss of consciousness (TLOC) is an apparent loss of consciousness with an abrupt onset, short duration, and spontaneous and complete recovery

  • TLOC is a distinct diagnostic group comprising syncope, generalized epileptic seizures, functional TLOC and a group of rare causes

  • Syncope is divided into reflex syncope, syncope due to orthostatic hypotension and cardiac syncope

  • Reflex syncope is by far the most common form of TLOC and might affect up to 40% of the population

  • Diagnosis of TLOC requires an understanding of key clues, pathophysiology and underlying epidemiological patterns, and entails a multidisciplinary approach

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Figure 1: Main features of TLOC and differential diagnoses.
Figure 2: Main forms of TLOC.
Figure 3: Circulatory patterns in syncope.
Figure 4: Events in reflex syncope.

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Acknowledgements

The authors are indebted to Ley Sander and Wil Hoefnagels for helpful comments on the manuscript.

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Author notes

  1. Department of Neurology, Section of Clinical Neurophysiology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands j.g.van_dijk@lumc.nl

Authors and Affiliations

  1. Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,

    J. Gert van Dijk

  2. Epilepsy Institute of the Netherlands (SEIN), Heemstede, The Netherlands.,

    Roland D. Thijs

  3. University of Minnesota Medical School, Cardiac Arrhythmia Center, Minneapolis, MN, USA.,

    David G. Benditt

  4. Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands.,

    Wouter Wieling

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van Dijk, J., Thijs, R., Benditt, D. et al. A guide to disorders causing transient loss of consciousness: focus on syncope. Nat Rev Neurol 5, 438–448 (2009). https://doi.org/10.1038/nrneurol.2009.99

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