Blood testing, electroencephalogram (EEG), magnetic resonance imaging (MRI) of the brain, echocardiography, head-up tilt test, carotid sinus massage, Holter monitoring, and loop recorders should be obtained only in specific contexts. Basic diagnostic workup of TLOC includes a thorough history and physical examination, and a 12-lead electrocardiogram (ECG). Nonsyncopal TLOC may be due to neurologic (epilepsy, sleep attacks, and other states with fluctuating vigilance), medical (hypoglycemia, drugs), psychiatric, or post-traumatic disorders. Rarely neurologic disorders (such as epilepsy, transient ischemic attacks, and the subclavian steal syndrome) can lead to cerebal hypoperfusion and syncope. The most common causes of syncopal TLOC include: (1) cardiogenic syncope (cardiac arrhythmias, structural cardiac diseases, others) (2) orthostatic hypotension (due to drugs, hypovolemia, primary or secondary autonomic failure, others) (3) neurally mediated syncope (cardioinhibitory, vasodepressor, and mixed forms). The term TLOC is used when the cause is either unrelated to cerebral hypoperfusion or is unknown. 2012 47(5):362-365.Syncope describes a sudden and brief transient loss of consciousness (TLOC) with postural failure due to cerebral global hypoperfusion. Cases of pediatric narcolepsy after misdiagnoses. Narcolepsy: signs, symptoms, differential diagnosis, and management. Complex movement disorders at disease onset in childhood narcolepsy with cataplexy. Impact of obesity in children with narcolepsy. Inocente CO, Lavault S, Lecendreux M, et al.Reducing the clinical and socioeconomic burden of narcolepsy by earlier diagnosis and effective treatment. Cataplexy features in childhood narcolepsy.
Darien, IL: American Academy of Sleep Medicine 2014. In: The International Classification of Sleep Disorders – Third Edition (ICSD-3) Online Version. Listening to the patient voice in narcolepsy: diagnostic delay, disease burden, and treatment efficacy. Maski K, Steinhart E, Williams D, et al.The clinical spectrum of childhood narcolepsy. Postiglione E, Antelmi E, Pizza F, Lecendreux M, Dauvilliers Y, Plazzi G.Clinical and therapeutic aspects of childhood narcolepsy-cataplexy: a retrospective study of 51 children. Aran A, Einen M, Lin L, Plazzi G, Nishino S, Mignot E.Cataplexy and its mimics: clinical recognition and management. Pillen S, Pizza F, Dhondt K, Scammell TE, Overeem S.Patients’ journeys to a narcolepsy diagnosis: a physician survey and retrospective chart review. Narcolepsy in children: a diagnostic and management approach. Insomnia, parasomnias, and narcolepsy in children: clinical features, diagnosis, and management. Narcolepsy with cataplexy is often confused with Sydenham chorea or PANDAS due to overlap of certain characteristics, such as episodic course, childhood onset with acute presentation following streptococcal infection, and coexistence of motor and behavioral symptoms that present similarly to cataplexy in narcolepsy in pediatric patients.Sydenham chorea and pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS) are brain autoimmune poststreptococcal diseases that occur in pediatric patients.Preserved consciousness distinguishes cataplexy from syncope.To differentiate cataplexy attacks from syncope, thorough screening for cardiac arrhythmias, head up tilt table testing, and video recordings of the attacks may be necessary.Loss of muscle tone and rapid recovery associated with cataplexy may be confused with syncope.Close to disease onset, cataplexy can mimic a spectrum of motor disorders and muscle diseases resulting in a misdiagnosis of myopathy.
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