Syncopal patients usually do not bite their tongue or have loss of bladder control (wet their patients) during an episode. They come around rapidly and know where they are ( they are not confused and disoriented after the episode).ħ. Once they fall to the ground and the blood rushes to their brain (as gravity has been eliminated), they rapidly regain consciousness.Ħ. Usually the loss of consciousness is of very short duration. I shall not go into the details here as then it shall become confusing).ĥ. There is an entity called syncopal convulsion where in the episode starts with a syncope but then goes on to become a seizure. Syncopal patients usually do not shake (that is they do not have convulsive movements. Syncope usually occurs in an upright position (patient is usually standing when it occurs). Blurring of vision at the onset of the episode ( Doctor I felt light headed, a little woosy, my vision started to go black and then I passed out)Ĥ. Feeling dizzy as if you are about to faint.ģ. Feeling light-headed prior to the episodeĢ. So what are the points which favor syncope?ġ. Another classical example of vasovagal syncope is when someone faints when he or she sees blood for the first time (frequently reported in medical students when they go into the OR for the first time). Vasovagal syncope on the other hand is more benign and our patient John likely had a vasovagal syncopal episode in case scenario No 1. Tests like ECG, prolonged 24 ECG (electrocardiogram) and sometimes an echocardiogram are ordered. As you can imagine these are potential lethal causes and hence patient’s who present with syncope are frequently evaluated for these cardiac conditions. So for example you can faint (have a syncopal episode) if you have a sudden massive heart attack, or a transient arrhythmia of the heart (the heart beat fluctuates). Syncope (fainting) can come either from the heart (we call this cardiogenic syncope) or from the brain (we call this neurogenic syncope or vasodepressor syncope or more commonly as vasovagal syncope). As you can imagine the treatment of both these conditions is very different. When a patient presents to a neurologist with an episode of loss of consciousness, it is imperative that we try to elucidate the underlying cause. So what are the points in the history which favor syncope and which favor a seizure? As many of you rightly guessed the first case scenario represents a typical syncopal episode while in the second case John had a generalized convulsion (seizure). Is it a seizure or is it syncope? the story continues….
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