Correspondence

Case 26-2005: Loss of Consciousness while Jogging

N Engl J Med 2006; 354:209January 12, 2006

Article

To the Editor:

We fear that the discussion of “syncope” in the Case Records, as in Binder et al. (Aug. 25 issue),1 may confuse readers. Seizures, hypoglycemia, and psychiatric conditions are considered causes of syncope (as listed in Table 1of the article), but these are incompatible with the later statement that “all forms of syncope result from a sudden decrease in cerebral blood flow.” The authors seem to use syncope in two different meanings, as occurs commonly in the literature.2 The first use (as in their Table 1) appears to mean transient loss of consciousness, a temporary, self-limited, and short-term loss of consciousness not due to mechanical trauma.3,4 We doubt the wisdom of this use, as few physicians would use the word syncope to identify epileptic seizures. The second meaning restricts the use of syncope to transient loss of consciousness due to cerebral hypoperfusion, conforming to the European Society of Cardiology guidelines.3,4 We suggest that the word be used in this sense only, and that specific terms such as syncope or seizure be used when the cause is clear; if not, the use of the more general phrase “transient loss of consciousness” forces physicians to keep an open mind regarding the diagnosis.3-5

J. Gert van Dijk, M.D.
Leiden University Medical Centre, 2300 RC Leiden, the Netherlands
j.g.van_dijk.neur@lumc.nl

David G. Benditt, M.D.
University of Minnesota Medical School, Minneapolis, MN 55455

Michele Brignole, M.D.
Ospedali del Tigullio, 16033 Lavagna, Italy

5 References

1. 1

   Case Records of the Massachusetts General Hospital (Case 26-2005). N Engl J Med 2005;353:824-832
   Full Text | Web of Science | Medline

2. 2

   Thijs RD, Benditt DG, Mathias CJ, et al. Unconscious confusion -- a literature search for definitions of syncope and related disorders. Clin Auton Res 2005;15:35-39
   CrossRef | Web of Science | Medline

3. 3

   Brignole M, Alboni P, Benditt DG, et al. Guidelines on management (diagnosis and treatment) of syncope -- update 2004: executive summary. Eur Heart J 2004;25:2054-2072
   CrossRef | Web of Science | Medline

4. 4

   Brignole M, Alboni P, Benditt DG, et al. Guidelines on management (diagnosis and treatment) of syncope -- update 2004. Europace 2004;6:467-537
   CrossRef | Web of Science | Medline

5. 5

   Thijs RD, Wieling W, Kaufmann H, van Dijk G. Defining and classifying syncope. Clin Auton Res 2004;14:Suppl 1:4-8
   CrossRef | Web of Science | Medline