Any age may suffer from dysrhythmias, sick sinus syndrome, AV block, seizures, electrolyte imbalances, volume depletion, hypoxia or hypoglycemia. Vasovagal syncope occurs while standing or sometimes while sitting, but is virtually unheard of in the supine or prone positions. This prodrome is NOT the same as the aura perceived by some patients with seizures or migraines. An abrupt loss of consciousness suggests epilepsy or a cardiac electrical disturbance. Pallor that persists and cyanosis may be seen with dysrhythmias.
Prolonged unconsciousness suggests severe left or right ventricular outflow tract obstruction.
If upon regaining consciousness the patient shows diminished alertness, abnormal tone or motor movements, slurred speech, impaired memory, sore muscles or focal neurologic deficits a seizure disorder should be suspected. Certain questions help clarify the etiology of syncopal episodes. Affirmative answers to the following questions suggest psychiatric causes for the syncope. This may be unassociated with cerebral hypoperfusion. Ask about the past medical history.