Favaron Elisa, Alboni Paolo
G Ital Cardiol (Rome). 2015 Jan;16(1):11-5. doi: 10.1714/1776.19240.
Affections such as psychogenic (functional) pseudosyncope and cataplexy are characterized by transient attacks without impairment of consciousness, but with loss of postural control and unresponsiveness. Therefore, these disorders should be differentiated from syncope and should not be ignored by the cardiologist, who is usually a reference point for patients with syncope or suspected syncope. Clinical findings that suggest psychogenic pseudosyncope include frequent attacks always in the presence of audience, a fall to the ground that may develop slowly enough to allow the patient to stagger and break the fall before hitting the floor, prolonged attacks (>10 min), many psychosomatic symptoms as the clinical context. In most cases, the differential diagnosis should be made with neurally mediated syncope; to this end, tilt test appears to be very useful. Cataplexy is a relevant symptom of narcolepsy; the differential diagnosis between cataplexy and syncope should be made only when symptoms of narcolepsy are mild. Clinical findings that suggest cataplexy include an emotional trigger - above all if the emotion is positive -, an "unreal" fall similar to that observed in patients with psychogenic pseudosyncope, repeated attacks in a daytime, symptoms of narcolepsy as the clinical context. Since cataleptic attacks are triggered by emotion, in most cases the differential diagnosis should be made with vasovagal syncope; a positive emotion as a trigger suggests a cataleptic attack.
心因性（功能性）假性晕厥和猝倒等病症的特点是短暂发作，意识无损害，但姿势控制丧失且无反应。因此，这些病症应与晕厥相鉴别，心脏病专家通常是晕厥或疑似晕厥患者的转诊医生，不应忽视这些病症。提示心因性假性晕厥的临床发现包括总是在有观众在场时频繁发作、倒地过程可能足够缓慢，使患者能够摇晃并在撞到地面之前摔倒、发作时间延长（>10分钟）、临床背景中有许多心身症状。在大多数情况下，应与神经介导性晕厥进行鉴别诊断；为此，倾斜试验似乎非常有用。猝倒是发作性睡病的一个相关症状；仅在发作性睡病症状较轻时才应进行猝倒与晕厥的鉴别诊断。提示猝倒的临床发现包括情绪触发因素——尤其是如果情绪为积极情绪——、类似于心因性假性晕厥患者所观察到的“不真实”摔倒、白天反复发作、临床背景中有发作性睡病症状。由于强直性发作由情绪触发，在大多数情况下，应与血管迷走性晕厥进行鉴别诊断；积极情绪作为触发因素提示强直性发作。
