Abstract: Syncope and autonomic failure are defined. Then the symptoms are
described. There are three types of neurally mediated syncope; situational,
carotid sinus hypersensitivity, and vasovagal syncope, which is the commonest
form. The diagnosis can most often be made by taking a detailed history, but
the tilt table test will help to confirm this. Details of the test are given.
The different terms that have been used to describe this form of syncope have
caused confusion, but neurally mediated syncope seems to be the best. There may
often be difficulties in differentiating neurally mediated syncope from
epilepsy, with all the problems a wrong diagnosis may cause, both personal and
social, especially in the case of reflex anoxic seizures. The ocular
compression test can help in making a definite diagnosis. Management will
include reassurance, and advice on avoiding situations, which may result in an
attack. Drugs are of limited value, and if syncope occurs frequently, cardiac
pacemakers may have to be considered. This is justified, not only by the
distress the attacks can cause to the individual, but also by such problems as
driving and working with machinery.