Blackouts

Question 1

What is a blackout?

Answer 1

Loss of conscious due to syncopal causes or nonsyncopal causes (hypoperfusion to the brain)

Question 2

List four syncopal

Answer 2

Reflex (vasovagal syncope, carotid sinus hypersensitivity and situational syncope)
Cardiac
Orthostatic
Cerebrovascular

Question 3

Non-syncopal causes of blackout

Answer 3

Intoxication
Head trauma
Metabolic
Psychogenic
Epileptic
Narcolepsy

Question 4

List some cardiac

Answer 4

Arrythmias

Question 5

Cause of cerebrovascular syncopal

Answer 5

Vertebrobasilar insufficiency

Question 6

What drop in BP causes orthostatic hypotension?

Answer 6

20mmHg systolic drop

10mmHg systolic drop

Question 7

Cause of cerebrovascular syncopal blackout

Answer 7

Vertebrobasilar insufficiency

Question 8

Precipitating factor

Answer 8

Postural triggers
Head turning indicates carotid sinus hypersensitivity
Whilst sitting or lying - cardiac arrhthmia
Exericse - primary cardiac pathology e..g aortic stenosis

Question 9

head trauma

Answer 9

Ask if on warfarin

Question 10

Questions about the episode

Answer 10

How long?
Did they bite their tongue?
Twitching and incontinence?
Recovery

Question 11

Name two causes of short lived blackouts

Answer 11

Vasovagal episode

Arrhythmia

Question 12

??????? recovery

Answer 12

Postictal confusion - takes epileptic patients about half an hour to regain their senses

Question 13

Name a specific type of cardiac syncope

Answer 13

Stokes-adams attack

Question 14

Name a specific type of cardiac syncope

Answer 14

Stokes-Adams attack

Question 15

Explain the Stokes-Adams attack

Answer 15

Sudden LOC due to a third degree block or any kind of sinoatrial disease leading to loss of CO
This results in a circulatory arrest, resulting in blood staying in the lungs, so once everything gets going again, the patient looks very rosey

Question 16

Generalised seizures

Answer 16

Tonic-clonic (rigidity then rhythmicl muscle contractions)
Absence
Simple
?????/

Question 17

What is syncope?

Answer 17

Hypoperfusion of the brain which results in loss of consciousness

Question 18

Give four syncopal causes of loss of consciousness

Answer 18

Reflex
Cardiac
orthostatic
Cerebrovascullar

Question 19

Give examples of triggers for reflex syncope

Answer 19

Standing for along time
Anything frightening
Straining (defecation)

Question 20

Give examples of cardiac causes of syncope

Answer 20

Aortic stenosis
Hypertrophic cardiomyopathy
Arrhythmias

Question 21

What is cerebrovascular syncope?

Answer 21

Syncope caused by non cardiac structural causes of reduced cerebral perfusion

Question 22

Give an example of what would cause cerebrovascular syncope

Answer 22

Obstruction of blood flow between heart and brain
e.g.

Aortic dissection
Haemorrhage

Question 23

What might cause orthostatic syncope?

Answer 23

Drugs (antihypertensives, antisympathetics)
Dehydration
Autonomic instability

Question 24

Another name for reflex syncope?

Answer 24

Vasovagal syncope

Question 25

Give examples of NON SYNCOPAL loss of consciousness

Answer 25

``` Intoxication Head trauma Metabolic (hypoglycaemia) Epileptic seizure Psychogenic non-epileptic seizure ```

Question 26

Differentiate between psychogenic non epileptic seizure vs epileptic seizure

Answer 26

Psychogenic ones are not neurologic in origin; they are somatic manifestations of psychologic distress (dropping their hand test - they prevent the hand from falling)

Question 27

How many episodes of seizure do you need to diagnose epilepsy?

Answer 27

More than 2 seizures

Question 28

Name two epileptic seizures which cause LOC

Answer 28

Complex partial | Generalised

Question 29

What would be the most likely causes of syncope in young people?

Answer 29

Vasovagal syncope | Aortic stenosis - congenital bicuspid aortic valve

Question 30

What would be the most likely causes of syncope in middle aged people?

Answer 30

Vasovagal syncope | Cardiac arrhythmias

Question 31

What would be the most likely causes of syncope in the elderly?

Answer 31

Orthostatic hypotension caused by medications