What happened just then? Demystifying the many causes behind syncope Premium

Syncope in clinical medicine: importance, causes, diagnosis, and management explained concisely by a medical professional.

‘The eyes see what the brain knows.’ This old adage, famous in the echelons of medicine, highlights why syncope is important in clinical medicine, for it is often missed while evaluating a patient.

Syncope is a transient loss of consciousness due to cerebral hypoperfusion. In simple terms, it is a brief cut-off from reality, which is accompanied by a loss of tone and posture, and ends with regaining of consciousness once perfusion to the brain is reinstated.

The path to the hospital for syncope is as varied as are its causes. It is the end effect of multiple pathologies - neural, orthostatic hypotension, cardiac, all of which have a peculiar origin - an evolutionary bane.

Humans adopted the upright posture to enable greater range for themselves. However this produced a unique physiologic stress on the body - to maintain constant perfusion pressure against gravity to the brain. Consequently, about 1 litre of blood gets pooled in the vascular plexus in the lower limbs, which draws from the central circulation. The workaround for this is cerebral autoregulation. Cerebral autoregulation refers to the brain’s ability to maintain constant/stable blood despite changes in blood volume of the central circulation.

When this cerebral autoregulation is altered, it leads to the final outcome of syncope, a transient, self-limited loss of consciousness, so brief that the patient or their caretakers might not even recognise it.

The following case study is one interesting example.

A 27-year-old male had presented to the orthopaedic department multiple times with recurrent fractures of the upper limb over the course of three months, all of which occurred in his washroom. It took a physician friend of the orthopaedic surgeon to link the falls in the washroom to micturition syncope (fainting while urinating), a rare type, where syncope occurs post urination highlighting the importance of interdisciplinary coordination in health.