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Head CT in Patients with Syncopal Episodes

Head CT in Patients with Syncopal Episodes. Mark Guzzo April 13, 2004. Literature Review. Impact of Diagnostic Tests in Evaluating Patients with Syncope Eagle KA, Black HR: Yale Journal of Biology and Medicine, 1983 Evaluation and Outcome of Patients with Syncope Kapoor, WN: Medicine, 1990

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Head CT in Patients with Syncopal Episodes

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  1. Head CT in Patients with Syncopal Episodes Mark Guzzo April 13, 2004

  2. Literature Review • Impact of Diagnostic Tests in Evaluating Patients with Syncope • Eagle KA, Black HR: Yale Journal of Biology and Medicine, 1983 • Evaluation and Outcome of Patients with Syncope • Kapoor, WN: Medicine, 1990 • The Role of Cranial Computed Tomography in Evaluation of Syncope in the Emergency Department • Slesinger, TL et al: Academic Emergency Medicine, 2002

  3. Eagle, et al. • Retrospective review • Tertiary Care Center- average age of patient 69; male 46%, female 54% • Review charts of 100 patients admitted for evaluation of syncope, 1976-78 • Noted all diagnostic tests used in the evaluation during that admission • 24 patients underwent Head CT – only one yielded etiology of syncope (we don’t know why these 24 pt’s were scanned or what diagnosis the one test revealed) [Eagle KA, Black HR. Impact of Diagnostic tests in Evaluating Patients with Syncope. Yale Journal of Biology and Medicine, 56 (1983), 1-8]

  4. Kapoor, WN • Retrospective review • Tertiary care hospital, inner city • Patients underwent standard eval. (h&p, cbc, p7, u/a, ekg, continuous ecg monitoring) +/- misc tests as suggested by hx (ct not included in standard eval.) • 433 pts (31% HTN, 12% DM, CAD 30%, CVA 8%, CRI 6%), mean age 56 [Kapoor WN, Evaluation and Outcome of Patients with Syncope. Medicine, 69 1990) 160-17]

  5. Kapoor, WN • Head CT done in 134 pts (why?) • Abnormal in 39 pts • Cerebral atrophy 19 • Old CVA 12 • Subdural Hematoma 5 • Meningioma 1 • Sellar mass 2 • Of 39 abnormal studies, only 1 was diagnostic [Kapoor WN, Evaluation and Outcome of Patients with Syncope. Medicine, 69 (1990) 160-174]

  6. Slesinger, et al. • Retrospective review • 204 pts, 135 (66%) received Head CT in the ED • 110 pts w/o neuro sx’s: CT’s non-contributory • 65% neg, 24% age-related atrophy, 13% old CVA • 25 pts had ms, focal deficits, sz activity • Only 2 had CT findings that may have contributed to cause of syncope [Slesinger TL, et al. Role of Cranial CT in Evaluation of Syncope in the ED, Acad Emerg Medicine, 9 (2002) 415.]

  7. Summary • No prospective clinical trial evaluating the utility of head CT in the emergent evaluation of syncope • Many studies revealing that CT scanning is rarely helpful • No studies show any benefit to CT scanning in syncope evaluation

  8. HUP ism • There appears to be no proven role for the routine use of Head CT in the evaluation of syncope in the absence of focal neurologic deficits or history suggestive of CNS abnormality.

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