Clinical features of patients with head injury after syncope

Abstract

The authors present two cases of syncope presenting as falls. A 62-year-old man hit on the forehead after an un­explained fall, whose dissecting aortic aneurysm turned out the cause of the collapse and a 72-year-old man presented with chronic subdural hematoma after frequent falls, whose arrhythmia (sick sinus syndrome) was proved responsible for the repeated faintness. With a careful history and physical examination, the victims of syncope should be detected among a great number of patients with head injury brought to the emergency departments, because they require different management from simple head injury. To get a clue to distinguish them more effectively, the authors compared the clinical features between 1027 patients with head injury after an accidental fall (group A) and 48 patients with head injury after syncope (group B). As a result, 221 frontofacial injuries (22%), 43 facial fractures (4.2%), and 801 upper limb injuries (78%) were found in group A and 18 (38%), 8 (17%), and 16 (33%) respectively in group B. During a fall, hands and arms are more often injured, because the upper extremities are usually extended to protect head and trunk due to postural reflexes. After syncope, global cerebral hypoperfusion might restrain those reflexes from working normally and consequently head and face may get more directly hurt without upper limbs protection. These results show that patients with head and face injury after an unexplained fall, especially when neither hands nor arms are injured, are most likely to be related with syncope and need further investigation.