Blackouts and 'funny do's'

Question 1

What are the commonest causes of blackout episodes with collapse?

Answer 1

Tonic-clonic seizure

Syncope

Question 2

What are the commonest causes of blackout episodes without collapse?

Answer 2

Focal seizure
Absent seizure
Transient ischaemic attack
Transient global amnesia
Migraine aura

Question 3

What are rarer causes of collapse?

Answer 3

SAH 
Intermittent hydrocephalus
Drop attack
Sleep disorders such as narcalepsy
Hypoglycaemia
Psychogenic seizures

Question 4

Describe what happens in a tonic-clonic seizure.

Answer 4

The patient may have a warning (aura) such as a smell/taste/strange feeling for a few seconds.
May see lip smacking or going black before losing consciousness.
Suddenly goes still and lets out a grunt. Arms and legs go stiff for a period and the jaw is tense.
The patient then may have jerking arm movements.
This goes on for 2-3 minutes.
When they come around the patient will be muddles.
May have lost urinary continence and bitten their tongue.

Question 5

What is the cause of syncope?

Answer 5

Results from a fall in blood pressure leading to cerebral hypoperfusion.

Question 6

What happens if a patient having a syncope episode is kept upright?

Answer 6

They have have a provoked ‘reflex-anoxic’ seizure (tonic-clonic).

Question 7

What are common causes of syncope?

Answer 7

Prolonged standing, in a hot place, after distress - vasovagal syncope.
Preceded by palpitation, occurs without prodrome or occurs on exertion - cardiac syncope
Hyperventilation/valsalva manoeurve
Particular situations such as micturition or coughing

Question 8

What are the prodromal symptoms of hypoglycaemia?

Answer 8

Sweating, feeling of fear, lightheadedness

Question 9

What is the classical cause of intermittent hydrocephalus?

Answer 9

Rare colloid cyst in the third ventricle

Question 10

What is the difference between a complex partial seizure and a partial seizure?

Answer 10

Complex partial seizure there is loss of consciousness.

Partial seizure = conscious.

Question 11

What is transient global amnesia?

Answer 11

For a period of 2-6 hours there is almost total failure to acquire new information and patients appear confused - they will repeat questions again and again.
They can do complicated things like driving.

Question 12

What disease is transient global amnesia associated with?

Answer 12

Migraine.

Question 13

What investigations should you do on someone who has suffered syncope?

Answer 13

ECG - all patients who faint.
Fasting glucose
14 hour ECG
Tilt-table test

Question 14

What investigations should you do on someone who has suffered a seizure?

Answer 14

EEG
MRI/CT brain scan
24 hour EEG
calcium

Question 15

What driving regulations are there after a syncope/seizure/TIA?

Answer 15

Single seizure or black out - licence revoked for one year. Reduced to 6 months if ECG and scan are normal.

Provoked seizure - dealt with by DVLA on an individual basis.

Recurrent seizures - revoked for one year.

Seizures only during sleep - can drive as long as all seizures for the last 3 years have only occurred during sleep.

TIA - Usually can drive 1 month after

Syncope - No effect on driving

Transient global amnesia - No effect on driving.

Question 16

What lifestyle advice do you give someone with seizures?

Answer 16

Avoid swimming, baths, doing anything that could put you or others at risk.