Ask About Hair-Grooming in a Patient With Unexplained Syncope Hair-Grooming Syncope in Children

Objective: To describe children undergoing cardiac evaluation for syncope for whom a trigger of hair-grooming has been identified. Participants/Methods: The authors, a group of cardiologists, looked at their experiences in outpatient consultations over a 9-year-period. Of >65,000 patients seen, 1525 who had syncope as their chief complaint were identified. Of these 1525 patients, 111 (7%) had hair grooming as the trigger. The authors then did a retrospective analysis of these patients' records for clinical observations. Results: Nearly 80% of patients were girls, who had a mean age of 11 years. Most males were cutting their hair when the syncope occurred, while most girls were combing or brushing their hair. Seventy-five percent of the patients were standing when the syncope occurred. Approximately 50% had previous syncopal episodes that were not hair-related. Nearly two-thirds had a prodrome prior to the collapse. In nearly 9 out of 10 patients, the event lasted <60 seconds. As part of the authors' standard protocol, all patients seen with syncope had both an electrocardiogram (ECG) and an echocardiogram done as part of the work-up. All 111 patients with hair-grooming syncope had ECGs and echocardiograms done. None had significant contributory arrhythmias or structural abnormalities. Conclusions: The authors concluded that in this group, the largest reported series of children presenting with syncope who had a hair-grooming trigger, this particular trigger appears to stimulate a benign form of neurocardiogenic reflex syncope. Reviewer's Comments: I must confess that I do not usually ask about personal hygiene actions (other than toileting) when confronted with a patient who has fallen down in the bathroom. However, I will now, as this study demonstrates that nearly 1 out of 10 syncopal episodes involving adolescents, at least in Las Vegas, are associated with fussing with the hair in one form or another. Hair grooming in selected individuals appears to be a powerful autonomic trigger. Since most of the episodes occurred while standing, there was likely some orthostatic-venous pooling that may have been involved. When such a trigger is identified, parents can be reassured that the likelihood of significant cardiac disease is very low (in this study, zero). However, the authors, who are cardiologists, do not make the leap of faith that more detailed studies can be eliminated if hair-grooming is the trigger for syncope. Of course, it is important to look for additional details of history involving both family and patient. If a patient with hair-grooming syncope is identified, he/she should be encouraged to drink fluids before and to sit down during the hair ritual. (Reviewer-Mark F. Ditmar, MD).