study date 12/17

Neurocardiogenic (Vasovagal) Syncope

Syncope preceded by warmth, nausea, diaphoresis, and prolonged standing is classic for neurocardiogenic (vasovagal) syncope.
Autonomic prodrome strongly favors a benign reflex mechanism rather than cardiac or neurologic causes.
Brief jerking or myoclonic movements can occur during syncope due to transient global cerebral hypoperfusion and do not indicate seizure.
Absence of tongue biting, urinary incontinence, and postictal confusion argues against epilepsy.

This patient has no high-risk features, including:
- Normal ECG
- Normal vital signs
- No chest pain or exertional syncope
- No structural heart disease
- Normal neurologic exam
A prior negative inpatient cardiac workup further lowers suspicion for malignant arrhythmia.

Patients with a clear presentation of neurocardiogenic syncope who have returned to baseline should be reassured and discharged with outpatient follow-up.
Additional testing or admission does not improve outcomes in low-risk vasovagal syncope.

Telemetry admission is reserved for patients with suspected cardiac syncope (eg, no prodrome, exertional syncope, abnormal ECG).
Ambulatory ECG monitoring is useful only if arrhythmia is suspected, which is unlikely here.
Brain imaging and EEG are not indicated without seizure features or focal neurologic deficits.
Tilt-table testing is used when the diagnosis is unclear; this patient already has a classic vasovagal presentation.

Patients with neurocardiogenic syncope have no increased risk of mortality, myocardial infarction, or stroke.

Classic vasovagal syncope with autonomic prodrome and normal evaluation → reassurance and outpatient follow-up, even if brief convulsive movements are present.

✅ Reassure and advise primary care provider follow-up