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Neurology > 1(E): tLOC > Flashcards

1(E): tLOC Flashcards

1
Q

What are 5 neurological causes of black-out

A
  • Epileptic seizure
  • Raised ICP
  • SAH
  • Narcolepsy
  • CVD
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2
Q

What are 3 cause of neural mediated syncope

A
  1. Carotid Sinus Syncope
  2. Vaso-vagal
  3. Situational syncope
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3
Q

What are 2 cardiac causes of syncope

A

Arrhythmias

Obstruction - HOCM, Aortic stenosis

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4
Q

What can cause orthostatic hypotension leading to syncope

A

Medication

Autonomic dysfunction - MS, PD, Diabetes

Addison’s

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5
Q

What metabolic disorders can cause syncope

A

Hypoxia

Hypoglycaemia

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6
Q

What psychiatric causes of syncope

A

Psychiatry non-epileptic attacks

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7
Q

Explain triggers in

a. Epilepsy
b. Syncope

A

a. Rare: flashing lights, alcohol, sleep deprivation

b. Common (eg. Blood, Dehydration)

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8
Q

Explain pro-drome in

a. Epilepsy
b. Syncope

A

a. May have an aura

b. Very common - lightheadedness, dizziness

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9
Q

Describe onset of seizure

A

Very quick

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10
Q

Describe onset of syncope

A

Gradual

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11
Q

Describe duration of seizure

A

1-3 minutes

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12
Q

Describe duration of syncope

A

30 seconds

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13
Q

What are common features of seizures. but not syncope

A

Tongue biting
Incontinence
Post-Ictal confusion

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14
Q

What colour are individuals during seizures

A

Blue - cyanosed

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15
Q

What colour are individuals during syncope

A

Pale

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16
Q

What is a vasovagal

A

Sudden bradycardia and peripheral vasodilation caused by external stimuli causes collapse

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17
Q

What are key features of vasovagal attacks

A

Pre-syncopal symptoms. Last seconds

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18
Q

Why may jerking occurring in vasovagal attacks

A

Hypoxia causing tonic-clonic jerks

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19
Q

What is situational syncope

A

LOC evoked in specific situations

20
Q

What is difference between situational syncope and vasovagal

A

Similar to vasovagal but evoked by certain events

21
Q

What. are two types of situational syncope

A
  • Micturition syncope

- Exertions syncope

22
Q

What are stoke adams attacks

A

Drop in CO leading to LOC, caused by arrythmia such as bradycardia due to heart block

23
Q

How does patient present in stoke adams attacks

A

Palpitations then suddenly drops to ground. During attack the pulse cannot be felt or is slow.

24
Q

Explain recovery in stokes adams

A

patient recovers in seconds, they flush, pulse speeds up and consciousness is regained

25
Q

What are drop attacks

A

Patient suddenly drops to ground without LOC

26
Q

What causes drop attacks

A
  • Narcolepsy
  • Cataplexy
  • Leg weakness
  • Hydrocephalus
27
Q

What should all individuals with tLOC have ordered

A

ECG

28
Q

What other blood tests should be ordered in tLOC

A 
Blood Glucose (hypoglycaemia) 
Hb (anaemia)
29
Q

If someone has a red-flag what should happen

A

Refer for urgent cardiovascular assessment in 24-hours

30
Q

What are red flags of tLOC

A
  • Abnormality ECG
  • tLOC during exercise
  • FH sudden cardiac death under 45-years
  • New-onset breathlessness
  • New murmur
  • HF
31
Q

Explain referral in over 65-years

A

Refer anyone over 65 with tLOC without prodrome for urgent cardiovascular assessment in 24-hours

32
Q

If suspected structural heart disease, what investigation is performed

A

ECHO

33
Q

If suspecting arrhythmia. what investigation is performed

A

Holter ECG (Ambulatory ECG)

34
Q

If suspect carotid sinus syndrome - what investigation is performed

A

Carotid Sinus Massage

35
Q

If unidentified cause of tLOC and patient is under 65 what is offered

A

Holter Monitor (Ambulatory ECG)

36
Q

If unidentified cause of tLOC and patient is over 65 what is offered

A

Carotid Sinus Massage

37
Q

If patient has tLOC several times a week, how long is hotter monitoring offered

A

48h

38
Q

If no event seen on holter monitor, what is offered

A

External event recorder

39
Q

If individual has tLOC every 1-2 weeks what is offered

A

External event recorder

40
Q

if individual has tLOC less than every 2 weeks what is offered

A

Implantable recorder

41
Q

If no red flags, who may tLOC be referred to

A

Neurology

42
Q

If suspect vasovagal or situational syncope, what is done

A

Nothing

43
Q

If suspect epilepsy, what is done

A

Refer to epilepsy specialist in 2W

44
Q

If suspect orthostatic hypotension what is done

A

Lying-standing BP

45
Q

Explain lying standing BP

A

Drop in 20/10mmHg after 3-minutes is positive

Neurology (26 decks)

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