From the Guidelines
Pseudosyncope is a condition characterized by apparent loss of consciousness without impaired cerebral perfusion or function, often related to psychological factors such as conversion disorder, anxiety, or depression. This condition involves episodes where a person appears to faint but maintains awareness throughout the event, typically resulting from psychological stressors rather than cardiovascular or neurological causes 1. Patients with pseudosyncope may experience slumping or falling, closed eyes, and limp muscles, making it challenging for observers to distinguish from true syncope.
Some key clinical features suggestive of pseudosyncope include a long apparent duration of loss of consciousness, frequent episodes, closed eyes, lack of pallor and diaphoresis, and usually little physical harm 1. A normal pulse, blood pressure, or EEG during a pseudosyncope episode can be documented, helping to differentiate it from true syncope. Diagnosis involves ruling out organic causes through tests like EEG monitoring, tilt-table testing, or video monitoring, which may show normal brain activity during episodes 1.
- Characteristics of pseudosyncope:
- Apparent loss of consciousness without impaired cerebral perfusion or function
- Often related to psychological factors such as conversion disorder, anxiety, or depression
- Episodes may involve slumping or falling, closed eyes, and limp muscles
- Normal brain activity during episodes, as shown by EEG monitoring or other tests
- Diagnostic approaches:
- Ruling out organic causes through tests like EEG monitoring, tilt-table testing, or video monitoring
- Tilt-table testing can help establish a diagnosis of pseudosyncope by showing normal blood pressure and heart rate during apparent unconsciousness 1
- Treatment:
- Primarily focuses on addressing underlying psychological factors
- Cognitive behavioral therapy, stress management techniques, and sometimes psychiatric medications if appropriate
- Compassionate approach to patients, recognizing the involuntary nature and genuine distress caused by pseudosyncope, even if it does not represent a physical threat to health like true syncope might 1.
From the Research
Definition of Pseudosyncope
- Pseudosyncope, also known as psychogenic pseudosyncope, is a condition that mimics syncope but does not involve a true loss of consciousness 2, 3, 4, 5, 6.
- It is characterized by a transient loss of postural tone and limp, motionless unresponsiveness with eyes closed, but without any hemodynamic or electroencephalographic modifications 4, 5.
Clinical Features
- Pseudosyncope often presents with prolonged duration of loss of consciousness, eye closure during the episode, unusual triggers, and no recognizable prodromes 3, 4, 6.
- Patients with pseudosyncope may experience a high frequency of attacks, and the condition can be triggered by suggestion or activation procedures 3, 5.
- The presence of an established diagnosis of syncope should not deter from the concomitant diagnosis of pseudosyncope 4.
Diagnosis
- The diagnosis of pseudosyncope can be made through a detailed history, clinical evaluation, and investigations such as head-up tilt testing (HUTT), electroencephalogram (EEG), or video-EEG monitoring 3, 4, 5, 6.
- The gold standard for diagnosis is the documentation of normal hemodynamic and electroencephalographic parameters during an attack 4.
- Pseudosyncope is not simply a diagnosis of exclusion and can be firmly diagnosed with the right investigations 5.
Management
- Treatment of pseudosyncope involves clear and empathetic communication of the diagnosis, which can lead to an immediate reduction of attack frequency and lower the need for emergency services 4.
- Pharmacological treatment of associated psychiatric disorders and psychological interventions, such as cognitive-behavioral therapy, may be beneficial in patients with pseudosyncope 4, 6.
- Limiting unnecessary interventions, providing the patient with needed structure, and encouraging functionality are also important aspects of management 6.