Pathophysiology

The final common pathway of syncope is a lack of vital nutrient delivery to the brainstem reticular activating system, leading to loss of consciousness and postural tone. Most commonly, an inciting event causes a drop in cardiac output, which, unless corrected rapidly, decreases oxygen and substrate delivery to the brain. Less commonly, vasospasm or other alterations in flow singularly reduce central nervous system blood flow. The reclined posture of syncope and the response of autonomic autoregulatory centers reestablish cerebral perfusion, leading to a spontaneous return of consciousness.

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