Mind-stretching faints.

Syncope has been defined as a transient, brief, self-limited loss of consciousness due to global cerebral hypoperfusion (Brignole et al. 2004). The specific pathophysiology sets syncope apart from other conditions causing transient loss of consciousness (TLOC), such as epilepsy. The major causes and mimics of TLOC are summarised in figure 1. History-taking is the most important tool to distinguish syncope from epilepsy. The paper by Mazzuca and Thomas (2007) on selfinduced stretch syncope published in this issue of the journal raises a number of important issues related to the pathophysiology and misdiagnosis of such paroxysmal events. Before discussing the historical features that are useful to discriminate between syncope and epilepsy, we will first briefly review the symptoms and classification of syncope.