Syncope in a general hospital patient population. Usefulness of the radionuclide brain scan, electroencephalogram, and 24-hour Holter monitor

The usefulness of the radionuclide brain scan, electroencephalogram, and 24-hour Holter cardiac monitor was evaluated in the assessment of 205 patients admitted to Montefiore Hospital for syncope. Brain scanning revealed no diagnostic abnormalities that resulted in medical intervention in patients without neurologic signs or symptoms, but it produced diagnostic information in 8% of patients with neurologic signs or symptoms (P <.05). The electroencephalogram did not provide evidence of a new seizure disorder in any patient. Holter monitoring uncovered arrhythmias predisposing to syncope in 21% of all patients. The diagnostic yield of the Holter monitor was the same in patients with and without neurologic findings. These results suggest that electroencephalography should not be performed routinely in patients admitted to hospital with syncope. Radionuclide brain scanning is of some diagnostic aid in patients with neurologic findings but of little use in patients without such findings. Holter cardiac monitoring appears to be a useful test for patients admitted with syncope.