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Logo of jnnpsycJournal of Neurology, Neurosurgery and PsychiatryVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
J Neurol Neurosurg Psychiatry. 2007 April; 78(4): 440.
PMCID: PMC2077795

Syncope Cases

Reviewed by Ann Johnston and Phil Smith

Edited by Roberto Garcia‐Civera, Gonzalo Baron‐Esquivivias, Jean‐Jacques Blanc, Michele Brignole, Angel Moya I Mitjans, Ricardo Ruiz‐Granell, Wouter Wieling. Published by Blackwell Publishing Professional, 2006, £40, pp 344. ISBN 9781405151092

Syncope is the most common cause of loss of consciousness. For those with personal experience it is a frightening event, yet clinicians are often poorly equipped to explain the problem and its mechanisms to patients. Most cases of syncope are currently managed in primary care; patients requiring investigation are often referred first to cardiologists rather than to neurologists.

Syncope Cases provides over 100 succinct (1–3 page) reports, most with a relevant illustration, expertly edited into a useful and practical text. The authors describe syncope in its many forms: reflex (neurally mediated) causes, carotid sinus syndrome, orthostatic hypotension, arrhythmogenic syncope and syncope from structural cardiac disease, as well as rarer causes such as syncope in myotonic dystrophy, Kearns–Sayre syndrome, subclavian steal, and the unusual presentations of swallow, glossopharyngeal, cough and laughter syncope. As with much in medicine, something seemingly straightforward becomes increasingly complex with its greater understanding. The 136 authors are almost exclusively from cardiology, yet the content is highly relevant to neurologists. Particularly helpful are explanations of tilt‐table testing physiology and of complex arrhythmias, and indications for electrophysiological studies and implantable loop recorders. An interesting diversion is the distinction between the “mess trick” and the “fainting lark” (with instructions on each). Surprisingly, there is no description of migraine syncope and little on psychogenic syncope.

We learn from cases better than from dry text. This book is highly readable and a useful clinical aid to the investigation and management of an array of syncope scenarios. It is a pleasure to read, but be prepared to feel unnerved on hearing of seemingly benign presentations of several potentially fatal syncopes.

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