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Syncope

Introduction:

Syncope is a sudden, transient loss of consciousness. It recovers rapidly without any neurological sequel. It is because of transient hypo-perfusion of the brain. It should be differentiated from convulsive seizure.

Differentiating Features Between Syncope & Convulsive Seizure

Syncope

Precipitating Factors

  • Prolonged standing
  • Voiding of urine
  • Prolonged coughing
  • Prolonged fasting
  • Alcohol intoxication
  • Strong emotional reaction

Premonitory Symptoms

  • Dizziness
  • Lightheadedness
  • Excessive perspiration
  • Epigastric discomfort
  • Blurring of vision or blackout
  • Facial pallor
  • Paresthesia

Others

  • Posture of the patient: Mostly occur in standing posture
  • Progression of unconsciousness: Mostly immediate
  • Duration of episode: Loss of consciousness occur for few seconds
  • Tongue bite: Rarely
  • Involuntary jerking movements of limbs: Rarely
  • Ictal urinary incontinence: Rarely
  • Post-ictal headache: Rarely

Convulsive Seizure

  • Precipitating factors: Usually none
  • Premonitory Symptoms: Aura or Déjà vu
  • Posture of the patient: Occur in any posture
  • Progression of unconsciousness: Slow over seconds
  • Duration of episode: Loss of consciousness occur for few minutes
  • Tongue bite: Frequent
  • Involuntary jerking movements of limbs
  • Frequent
  • Lip smacking
  • Staring
  • Random eye movements
  • Ictal urinary incontinence: Frequent
  • Post-ictal headache: Frequent

Reference(s):

  • Bergfeldt, L. “Differential diagnosis of cardiogenic syncope and seizure disorders.” Heart, vol. 89, no. 3, Mar. 2003, pp. 353–58, doi:10.1136/heart.89.3.353.
  • Roberts, James R. “InFocus: Clinically Differentiating Seizure from Syncope.” Emergency Medicine News, vol. 39, no. 6, 2017, pp. 8–9, doi:10.1097/01.EEM.0000520580.50718.46. 

✍️ Self-Assessment

🤔 True and False statements:

  • Dizziness and headache present following syncopal attack
  • Loss of consciousness for few seconds to minutes
  • Occur more during standing posture
  • Prodromal symptoms present
  • Seizures are common
 
 

🙋 Answer(s):

[Answers are: Dizziness and headache present following syncopal attack-False, Loss of consciousness for few seconds to minutes-True, Occur more during standing posture-True, Prodromal symptoms present-False, Seizures are common-False]
Okay, hope till now you are able to understand the concept question. Let us assess one more question below!



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