The Child Who Passes Out

Abstract

1. Hassib Narchi, MD* 1. 2. *Pediatric Department, Sandwell General Hospital, West Bromwich, United Kingdom. After completing this article, readers should be able to: 1. Distinguish among seizures; breath-holding or pallid spells; vasovagal syncope; cardiac, neuropsychiatric, and sleep disturbances; tics; syncope; and gastroesophageal reflux. 2. Describe the etiologies for breath-holding spells. 3. Recognize prolonged QT syndrome in a patient who has syncope. 4. Delineate the importance of cardiovascular evaluation in patients who have syncopal or presyncopal episodes with exercise. 5. Plan the evaluation of a child who has recurrent unexplained syncope. 6. Design a therapeutic program for the management of breath-holding spells. A previously well 2-year-old boy who had an uneventful neonatal period; normal growth parameters and developmental milestones; and a negative family history for seizures, syncope, or sudden death was referred for evaluation of episodes of loss of consciousness that were stereotypic and occurred twice weekly over the previous 6 months. He developed unexpected episodes of sudden pallor after a minor trauma, followed by a fall, loss of consciousness, turning of the eyes, opisthotonos, and clonic movements for 30 seconds. He recovered normal consciousness and activity over the next few minutes before drifting to sleep. There was no cyanosis or sweating, and the episodes were not related to exercise or fasting. Results of a complete physical examination, including growth parameters, vital signs, and neurologic examination, were normal. Results of a tilt table test were normal, electrocardiography (ECG) showed a sinus rhythm, the corrected QTc interval was 0.40 seconds, and electroencephalographic (EEG) findings were normal. An EEG with an ocular compression test revealed bradycardia with a brief reversible asystole of 4 seconds, which recovered spontaneously, confirming the diagnosis of pallid spells or reflex anoxic seizures. Syncope or fainting, defined as a sudden and usually brief loss of consciousness and postural tone, is caused by a transient decrease in cerebral blood flow. Presyncope is the feeling that one is “about to pass …