Diagnostic yield of neuroimaging in syncope patients without high-risk symptoms indicating neurological syncope

Am J Emerg Med. 2019 Feb;37(2):228-230. doi: 10.1016/j.ajem.2018.05.033. Epub 2018 May 16.


Objectives: Diagnostic tests are widely used for patients with syncope in the emergency department (ED). This study aimed to determine the diagnostic yield of neuroimaging in patients with syncope without high-risk symptoms.

Methods: Adult patients who presented to the ED with syncope in 2016 were screened retrospectively. Patients who suffered from mild head trauma due to syncope were also included. Patients with neurological examination findings (confusion, amnesia, focal neurological deficit, severe headache, dizziness, nausea and vomiting), patients on anticoagulants, patients with known intracranial malignancies and those whose loss of consciousness was attributed to reasons other than syncope were excluded from the study.

Results: A total of 1114 patients were included in the study. The median age was 48 years (IQR = 34-66 years) and 576 (51.7%) of the patients were male. The neuroimaging tests performed were cranial computerized tomography (CT) in 694 (62.3%) cases and magnetic resonance imaging (MRI) in 114 (10.2%) cases. Mild head trauma due to syncope was observed in 116 (10.4%) patients. None of the neuroimaging studies revealed any clinically significant findings.

Conclusion: Neuroimaging is not beneficial in patients whose medical history and physical examination do not indicate neurogenic syncope, even if the patient has mild head trauma.

Keywords: Cranial CT; Cranial MRI; Emergency department; Neuroimaging; Syncope.

MeSH terms

  • Adult
  • Aged
  • Craniocerebral Trauma / diagnostic imaging
  • Craniocerebral Trauma / etiology
  • Emergency Service, Hospital
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Medical History Taking
  • Middle Aged
  • Neuroimaging* / methods
  • Neurologic Examination
  • Retrospective Studies
  • Risk Factors
  • Syncope / complications
  • Syncope / diagnostic imaging*
  • Tomography, X-Ray Computed