Syncope confusion

We thank Thiruganasambandamoorthy and Sheldon for clarifying the definition of syncope as a transient loss of consciousness due to global cerebral hypoperfusion characterized by rapid onset, short duration and spontaneous complete recovery.1 However, experts acknowledge that this approach has pragmatic limitations, particularly when applied to undifferentiated patient presentations in the emergency department. To guide clinicians in the emergency department, our approach focuses on all potential causes of transient loss of consciousness, including syncope “mimickers.” We agree that stroke, transient loss of consciousness, seizure and metabolic disturbances do not represent true syncope.