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Here is a quick mnemonic “TRANSIENT CHANGE to remember about Neurally Mediated 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

Neurally Mediated Syncope : How To Remember Easily ?

  • T – Transient change: There is a transient change in autonomic efferent activity with increased parasympathetic outflow.
  • R – Reduced vasoconstrictor tone: The transient change results in reduced vasoconstrictor tone.
  • A – Autonomic nervous system: A functioning autonomic nervous system is necessary for neurally mediated syncope.
  • N – Neurological reflex arc: Neurally mediated syncope is the final pathway of a complex central and peripheral nervous system reflex arc.
  • S – Syncope triggers: Multiple triggers of the afferent limb of the reflex arc can result in neurally mediated syncope.
  • I – Integration in the medulla: Different afferent pathways converge on the central autonomic network within the medulla.
  • E – Emotion and orthostatic stress: Vasovagal syncope (the common faint) is provoked by intense emotion, pain, and/or orthostatic stress.
  • N – Neurological impulses: The central autonomic network mediates the neural impulses in neurally mediated syncope.
  • T – The afferent triggers for syncope may originate in various systems, including the pulmonary, gastrointestinal, urogenital, cardiac, and carotid sinus.
  • C – Cardiac output reduction: The transient change leads to reduced cardiac output.
  • H – Hypocarbia and vasoconstriction: Hyperventilation leading to hypocarbia and cerebral vasoconstriction plays a central role in situational reflex syncopes.
  • A – Afferent and efferent pathways: The afferent pathway of the reflex arc differs among disorders, but the efferent response via the vagus and sympathetic pathways is similar.
  • N – Neurological mechanisms: The underlying mechanisms have been identified and pathophysiology delineated for most situational reflex syncopes.
  • G – Gastrointestinal and bladder stimuli: Stimuli of the gastrointestinal tract or the bladder can be triggers for neurally mediated syncope.
  • E – Efferent pathway classification: Neurally mediated syncope can be subdivided based on the predominant efferent pathway.


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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 working in department