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Syncope in a Teen A 17 year old high school female fainted while driving to work which resulted to a head on collision at 40 miles per hour. She was alert and knows the environment after the accident. She complained of sternal pain (middle of the chest), left chest and shoulder pain, and right jaw pain. The evaluation at the Emergency room showed that she had abrasion at the middle of the chest, non displaced fracture of the left clavicle and mandible. Her chest x ray showed left pneumothorax (air outside the lungs). The neurologic examination was normal. She is not using any alcohol or street drugs, however she said that in the past 9 months, she had brief spells of lightheadedness, sweating, nausea, and visual blackouts. One of these episodes lead to a fainting spell. By lying down, she could stop these spells of lightheadedness. She did not have palpitation nor confusion associated with it. These spells occur more often before her menses, which is irregular but not heavy. She had menses 16 hours after the car accident. Her family history revealed that her mother had similar spells as a teenager. There was no family history of heart irregularity or sudden death. They eat low fat and salt diet. She had a chest tube to correct the pneumothorax and her jaw was fixed with an arch bar. The heart evaluation using a Holter monitor, ECG, pregnancy test, and other blood tests were all normal. Answer: Neurally mediated Syncope or Vasovagal syncope Reference: Pediatrics In Review, August 1996, page 291 Leo Leonidas, MD, FAAP, Assistant Clinical Professor in Pediatrics, Tufts University School of Medicine, Boston; Attending Pediatrician, Eastern Maine Medical Center, Bangor, Maine.
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