1(E): tLOC Flashcards
What are 5 neurological causes of black-out
- Epileptic seizure
- Raised ICP
- SAH
- Narcolepsy
- CVD
What are 3 cause of neural mediated syncope
- Carotid Sinus Syncope
- Vaso-vagal
- Situational syncope
What are 2 cardiac causes of syncope
Arrhythmias
Obstruction - HOCM, Aortic stenosis
What can cause orthostatic hypotension leading to syncope
Medication
Autonomic dysfunction - MS, PD, Diabetes
Addison’s
What metabolic disorders can cause syncope
Hypoxia
Hypoglycaemia
What psychiatric causes of syncope
Psychiatry non-epileptic attacks
Explain triggers in
a. Epilepsy
b. Syncope
a. Rare: flashing lights, alcohol, sleep deprivation
b. Common (eg. Blood, Dehydration)
Explain pro-drome in
a. Epilepsy
b. Syncope
a. May have an aura
b. Very common - lightheadedness, dizziness
Describe onset of seizure
Very quick
Describe onset of syncope
Gradual
Describe duration of seizure
1-3 minutes
Describe duration of syncope
30 seconds
What are common features of seizures. but not syncope
Tongue biting
Incontinence
Post-Ictal confusion
What colour are individuals during seizures
Blue - cyanosed
What colour are individuals during syncope
Pale
What is a vasovagal
Sudden bradycardia and peripheral vasodilation caused by external stimuli causes collapse
What are key features of vasovagal attacks
Pre-syncopal symptoms. Last seconds
Why may jerking occurring in vasovagal attacks
Hypoxia causing tonic-clonic jerks
What is situational syncope
LOC evoked in specific situations
What is difference between situational syncope and vasovagal
Similar to vasovagal but evoked by certain events
What. are two types of situational syncope
- Micturition syncope
- Exertions syncope
What are stoke adams attacks
Drop in CO leading to LOC, caused by arrythmia such as bradycardia due to heart block
How does patient present in stoke adams attacks
Palpitations then suddenly drops to ground. During attack the pulse cannot be felt or is slow.
Explain recovery in stokes adams
patient recovers in seconds, they flush, pulse speeds up and consciousness is regained
What are drop attacks
Patient suddenly drops to ground without LOC
What causes drop attacks
- Narcolepsy
- Cataplexy
- Leg weakness
- Hydrocephalus
What should all individuals with tLOC have ordered
ECG
What other blood tests should be ordered in tLOC
Blood Glucose (hypoglycaemia) Hb (anaemia)
If someone has a red-flag what should happen
Refer for urgent cardiovascular assessment in 24-hours
What are red flags of tLOC
- Abnormality ECG
- tLOC during exercise
- FH sudden cardiac death under 45-years
- New-onset breathlessness
- New murmur
- HF
Explain referral in over 65-years
Refer anyone over 65 with tLOC without prodrome for urgent cardiovascular assessment in 24-hours
If suspected structural heart disease, what investigation is performed
ECHO
If suspecting arrhythmia. what investigation is performed
Holter ECG (Ambulatory ECG)
If suspect carotid sinus syndrome - what investigation is performed
Carotid Sinus Massage
If unidentified cause of tLOC and patient is under 65 what is offered
Holter Monitor (Ambulatory ECG)
If unidentified cause of tLOC and patient is over 65 what is offered
Carotid Sinus Massage
If patient has tLOC several times a week, how long is hotter monitoring offered
48h
If no event seen on holter monitor, what is offered
External event recorder
If individual has tLOC every 1-2 weeks what is offered
External event recorder
if individual has tLOC less than every 2 weeks what is offered
Implantable recorder
If no red flags, who may tLOC be referred to
Neurology
If suspect vasovagal or situational syncope, what is done
Nothing
If suspect epilepsy, what is done
Refer to epilepsy specialist in 2W
If suspect orthostatic hypotension what is done
Lying-standing BP
Explain lying standing BP
Drop in 20/10mmHg after 3-minutes is positive
