Neurocardiogenic Syncope: Likelihood Ratios

Introduction:

Versus Ischemic Stroke. See also Subarachnoid Hemorrhage which shares some of the same findings (i.e. when intraparenchymal blood crosses into the subarachnoid space).

Great review of many findings (not all listed here): JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280

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Tags: Cardiac Problem Neurologic Tag this Diagnosis.

Differential Diagnoses include: Stroke, Syncope

Prevalence

Population / Calculator	Prevalence	Comments / Study / Link
Patients with syncope	33%	J Am Coll Cardiol 2001 Jun 1;37(7):1921-8. PMID 11401133
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The likelihood ratios of findings for Neurocardiogenic Syncope are listed below. See the left navigation bar to change the display.

Good Positive and Negative Likelihood Ratios

Xanthochromia

14.2

0.3

(in CSF)

Differential Diagnosis: Stroke

Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280

Clinical diagnosis

6.3

0.3

Differential Diagnosis: Stroke

Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280

Good Negative Likelihood Ratio

Tilt Table Test

1.7

0.5

resulting in syncope after isoproterenol administration

Differential Diagnosis: Syncope

Study: Ann Intern Med 1992 Mar 1;116(5):358-63. PMID 1736767

Good Positive Likelihood Ratio

Finding	+LR	-LR	Comments, Study
Kernig or Brudzinski Sign	7.5	0.9	Differential Diagnosis: Stroke Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
Neck Stiffness	6.7	0.8	Differential Diagnosis: Stroke Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
Coma	5.8	0.7	Differential Diagnosis: Stroke Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
Seizure	4.5	0.9	Differential Diagnosis: Stroke Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
Hypertension	4.4	0.6	diastolic > 110mmHg Differential Diagnosis: Stroke Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
Headache	2.6	0.7	Differential Diagnosis: Stroke Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280

Negative Findings

Finding	+LR	-LR	Comments, Study
Carotid Bruit	0.1	1.1	Differential Diagnosis: Stroke Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
Atrial Fibrillation	0.1	1.2	on EKG Differential Diagnosis: Stroke Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
Alert	0.3	2.5	i.e. as opposed to drowsy or comatose Differential Diagnosis: Stroke Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
Prior TIA	0.3	1.2	Differential Diagnosis: Stroke Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280

Poorly Diagnostic Findings

Acute Onset

0.6

1.8

Differential Diagnosis: Stroke

Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280