Drowning
Normally respiration does not cease with syncope, and on land when the person collapses, cerebral blood flow is increased, resulting in return to consciousness. When syncope occurs in an aquatic environment, the body attempts to breathe, but instead of taking in air, water enters the airway, triggering laryngospasm and consequent inability to breathe. This initiates the drowning process.22 With increasing hypoxia, the laryngospasm abates and further aspiration of water may occur. This often (30-50%) results in post-drowning pneumonia in survivors.22 Such was the case in the case report above. When drowning occurs in cold water environments, the body and brain may cool sufficiently to prevent massive cerebral damage, but in heated water, the increase in brain metabolism combined with hypoxia may be catastrophic.22