Neurocardiogenic Syncope: Sensitivity and Specificity

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 sensitivity and specificity of findings for Neurocardiogenic Syncope are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)


Finding	Result	Sensitivity	Specificity
[ + ] Tilt Table Test	+ 0 -	75%	55%
resulting in syncope after isoproterenol administration Study: Ann Intern Med 1992 Mar 1;116(5):358-63. PMID 1736767


Finding	Result	Sensitivity	Specificity
[ + ] Acute Onset	+ 0 -	44%	32%
Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
[ + ] Alert	+ 0 -	23%	31%
i.e. as opposed to drowsy or comatose Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
[ + ] Atrial Fibrillation	+ 0 -	2%	82%
on EKG Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
[ + ] Carotid Bruit	+ 0 -	1%	93%
Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
[ + ] Clinical diagnosis	+ 0 -	76%	88%
Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
[ + ] Coma	+ 0 -	35%	94%
Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
[ + ] Headache	+ 0 -	46%	82%
Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
[ + ] Hypertension	+ 0 -	48%	89%
diastolic > 110mmHg Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
[ + ] Kernig or Brudzinski Sign	+ 0 -	15%	98%
Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
[ + ] Neck Stiffness	+ 0 -	20%	97%
Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
[ + ] Prior TIA	+ 0 -	7%	79%
Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
[ + ] Seizure	+ 0 -	9%	98%
Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280
[ + ] Xanthochromia	+ 0 -	71%	95%
(in CSF) Study: JAMA 2010;303(22):2280-2286 http://jama.ama-assn.org/cgi/content/short/303/22/2280