UMEM Educational Pearls

Category: Neurology

Title: Neuroimaging in Syncope - Is It Necessary?

Keywords: Syncope, neurological, neuroimaging, CT, MRI (PubMed Search)

Posted: 6/13/2018 by WanTsu Wendy Chang, MD (Updated: 3/28/2024)
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  • The use of neuroimaging in syncope-related ED visits increased from 21% in 2001 to 45% in 2010.
  • A recent single-center retrospective study of 1114 patients who presented to the ED with syncope found that 62.3% patients underwent CT, while 10.2% underwent MRI.
  • A subset of patients (10.4%) sustained mild head trauma (GCS 14-15) due to syncope and all received neuroimaging.
  • Neuroimaging studies were not found to be beneficial in patients without features of:
    • Confusion
    • Amnesia
    • Focal neurological deficit
    • Dizziness
    • Severe headache
    • Nausea and vomiting
    • Signs of serious head injury
    • Intracranial malignancies
    • Use of anticoagulant drugs

Bottom Line: Consider obtaining neuroimaging in patients presenting with syncope only if clinical features suggest probable neurological syncope.

References

 

  • Idil H, Kilic TY. Diagnostic yield of neuroimaging in syncope patients without high-risk symptoms indicating neurological syncope. Am J Emerg Med. 2018 May 16 [Epub ahead of print]
  • Probst MA, Kanzaria HK, Gbedemah M, Richardson LD, Sun BC. National trends in resource utilization associated with ED visits for syncope. Am J Emerg Med. 2015;33(8):998-1001.

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