Although an uncommon cause for syncope, providers must consider a neurological cause in every patient presenting with transient loss of consciousness. In the absence of signs or symptoms concerning for neurological causes of syncope (such as but not limited to focal neurological deficits), the utility of neuro-imaging studies are of limited benefit. Despite a lack of evidence for the diagnostic utility of neuroimaging in patients presenting with true syncope, providers continue to perform brain computed tomographic (CT) scans. Thus, inappropriate use of this diagnostic imaging modality carries high costs and subject patients to the risks of radiation exposure.
Sources:
Alboni P, et al. Diagnostic value of history in patients with syncope with or without heart disease. J Am Coll Cardiol. 2001 Jun 1;37(7):1921-8. PMID: 11401133.
Grossman SA, et al. The yield of head CT in syncope: A pilot study. Intern Emerg Med. 2007 Mar;2(1):46-9. PMID: 17551685.
Mendu ML, et al. Yield of diagnostic tests in evaluating syncopal episodes in older patients. Arch Intern Med. 2009 Jul 27;169(14):1299-305. PMID: 19636031.
Strickberger SA, et al. AHA/ACCF scientific statement on the evaluation of syncope: From the American Heart Association councils on clinical cardiology, cardiovascular nursing, cardiovascular disease in the young, and stroke, and the quality of care and outcomes research interdisciplinary working group; and the American College of Cardiology Foundation: In collaboration with the Heart Rhythm Society: Endorsed by the American Autonomic Society. Circulation. 2006 Jan 17;113(2):316-27. PMID: 16418451.
Sheldon RS, et al. Standardized approaches to the investigation of syncope: Canadian cardiovascular society position paper. Can J Cardiol. 2011 Mar-Apr;27(2):246-53. PMID: 21459273.
Schnipper JL, et al. Diagnostic yield and utility of neurovascular ultrasonography in the evaluation of patients with syncope. Mayo Clin Proc. 2005 Apr;80(4):480-8. PMID: 15819284.
Task Force for the Diagnosis and Management of Syncope, et al. Guidelines for the diagnosis and management of syncope (version 2009). Eur Heart J. 2009 Nov;30(21):2631-71. PMID: 19713422.