You are currently viewing Differential Diagnosis of Syncope Mnemonic

Here is a quick mnemonic “SYNCOPE DIFFERENCE to remember about Differential Diagnosis of Syncope

This can be valuable for patients as well as medical doctors, nurses & students doing their clinical rounds. You can also find it very useful for med exams like USMLE, NEET PG, FMGE, NExT & NCLEX exams

Differential Diagnosis of Syncope : How To Remember Easily ?

  • S – Seizures: Syncope is often confused with generalized and partial seizures, but there are differentiating features. Generalized seizures have tonic-clonic movements, while myoclonic and other movements may occur in syncopal episodes.
  • Y – Yes to Auras: Partial or partial-complex seizures with secondary generalization are usually preceded by an aura, such as an unpleasant smell, fear, anxiety, or abdominal discomfort. These should be differentiated from the premonitory features of syncope.
  • N – Non-Autonomic Auras: Autonomic manifestations of seizures may resemble syncope, but the presence of accompanying non-autonomic auras can help differentiate the episodes from syncope.
  • C – Consciousness: Loss of consciousness associated with a seizure lasts longer (>5 min) and is associated with prolonged postictal drowsiness and disorientation. In contrast, reorientation occurs almost immediately after a syncopal event.
  • O – Other Differences: Muscle aches, emotions, pain, and fecal incontinence are more commonly associated with seizures rather than syncope.
  • P – Prolonged Symptoms: Hypoglycemia-related loss of consciousness typically occurs in individuals with diabetes. Clinical features include tremor, palpitations, anxiety, diaphoresis, hunger, and paresthesias. These symptoms are not typical premonitory features of syncope.
  • E – Emotions and Laughter: Cataplexy, characterized by the loss of muscular tone triggered by strong emotions like anger or laughter, is different from syncope as consciousness is maintained throughout the attacks.
  • D – Differentiating from Falls: The clinical interview and eyewitness interrogation can help differentiate syncope from falls due to other conditions like vestibular dysfunction or gait disorders. Diagnostic challenges may arise in patients with dementia or head trauma.
  • I – Injured or Not: Fainting without prodromal symptoms may be a manifestation of psychiatric disorders, whereas syncope, particularly vasovagal syncope, is accompanied by hemodynamic changes like hypotension and bradycardia.
  • F – Falls: Falls without prodromal symptoms are more likely associated with psychiatric disorders, while vasovagal syncope is accompanied by hypotension and bradycardia.
  • F – Frequently without Injuries: Patients with psychiatric disorders faint frequently without prodromal symptoms, but they are rarely injured despite numerous falls.
  • E – Emotions and Distress: Transient loss of consciousness due to vasovagal syncope is accompanied by hemodynamic changes like hypotension and bradycardia and can be precipitated by fear, stress, anxiety, and emotional distress.
  • RRemember the Differences: Keep in mind the distinguishing features between syncope and other conditions to make an accurate diagnosis.
  • E – Evaluate Carefully: Assess the patient’s symptoms, history, and associated features carefully to differentiate syncope from other disorders.
  • N – Narcolepsy: Cataplexy, characterized by abrupt loss of muscular tone triggered by emotions, occurs in a significant percentage of patients with narcolepsy.
  • C – Clear History: In patients with dementia or head trauma, obtaining a clear history of the episodes can be challenging, which may contribute to diagnostic difficulty.
  • E – Explore Psychiatric Disorders: Consider psychiatric disorders such as generalized anxiety, panic disorders, major depression, and somatization disorder as potential causes of apparent loss of consciousness without prodromal symptoms.


Dr. Arin Nandi

Passionate About Medical Science & Helping Future Doctors Achieve Top Ranks In Medical Exams. He is professionally a dentist as well as a public health expert from JIPMER (1), (2)working in health department