Blackouts, Funny Turns and Dizziness Flashcards
What are blackouts?
-Episodes of loss of consciousness
=Consciousness is not a simply localised brain function
=Blackouts results from something that affects the brain GLOBALLY
What are the general causes of blackouts?
-Syncope
-Epileptic seizure
=Then dissociative attack
What is syncope?
-Loss of consciousness due to hypoperfusion of the brain
Types of syncope
- Vaso-vagal (reflex)
- Postural hypotension (failure of autonomic NS)
- Cardiac (dysthymic/ structural)
What are epileptic seizure blackouts?
-Consciousness lost due to abnormal electrical discharges in the brain
Types of epileptic seizure
- Generalised epileptic seizures
- Complex partial seizures
Clinical information needed to diagnose blackouts
- Clinical background
- Immediate context
- Onset of attack
- During attack (eye witness)
- Recovery from attack
Clinical background for diagnosing blackouts
- Age
- PMH (brain injury)
- FH (inherited condition for epilepsy)
- Drug history
Differentiating between epilepsy and syncope
-Favours epilepsy:
=long duration, post-event confusion (long recovery), cyanosis, sever biting of sides of tongue
-Both:
=Pallor, jerking, warning and stiffness
What are the other causes of blackouts?
- Functional blackouts
- Non-epileptic attack disorder
- Dissociative attacks
- Hypoglycaemia (diabetes on treatment)
Investigations for blackouts
- Depending on context, none
- ECG (conduction abnormality)
-In certain syncope cases
=Ambulatory ECG
=Tilt table testing
-In selected epilepsy cases:
=Routine EEG (limited utility confirming epilepsy, useful for classification type)
=Video-telemetry ECG (difficult cases)
=Cerebral imaging (cause of epilepsy)
What are funny turns?
- Discrete episode(s)
- Due to some sort of brain event
- Deliberately vague/ inclusive definition unusual to patient
- Tend to reflect localised brain dysfunction
- Affecting a particularly focal brain area
General causes of funny turns
- TIA
- Epileptic seizure
- Migraine
What questions are used to differentiate funny turns?
-Onset/course
=Sudden onset/ simultaneous (multiple features)
=Sudden (occur at once) or spreading (develop)
-Sequential (multiple events)
-Nature
=Negative (loss of function)
=Positive
=Mixed
TIA as funny turn
-Dysphagia and loss of limb power
=Sudden and simultaneous, negative
Migraine as funny turn
- Tingling in arm, spreading over 15 minutes, followed by dysphagia (positive, spreading, sequential)
- Spreading, coloured pattern in vision with visual loss (spreading mixed)
Epilepsy as funny turn
-Twitching fingers, spreading up arm, to whole arm twitching (positive, spreading and sequential)
Other causes of funny turns
- Dissociation/ depersonalisation/ derealisation
- Anxiety/ panic attacks
- Hypoglycaemia
- Parasomnias
Investigations of funny turns
- Clearly migraine= none
- TIA/ epilepsy= appropriate investigation
What could a patient mean when describing dizziness?
- Imbalance (legs not head)
- Pre-syncope
- ‘Funny feeling’
- Vertigo
What is vertigo?
-On or more:
=A distortion of static gravitational orientation
=An erroneous perception of movement of the sufferer
=An erroneous perception of movement of the environment
(not all vertigo is rotational vertigo)
Main causes of vertigo
- Unusual stimulation of intact systems (motion sickness)
- Pathological dysfunction of those systems
Three structural items dealing with static gravitational orientation and perception of motion
-Visual
-Vestibular (acceleration)
-Somatosensory
-Feed information to the vestibular nucleus in the brainstem
=motion perception and spatial orientation
=eye movements
=posture
=Mismatch= vertigo
Components of vertigo syndrome
- Oculomotor: nystagmus, ocular deviation
- Autonomic: nausea, vomiting, sweating
- Postural: ataxia, falls
- Perceptual: vertigo, disorientation
- Secondary: anxiety, avoidance behaviour
-Peripheral (inner ear) vs central (brainstem)
Classifying vertigo (time)
- Acute vertigo
- Recurrent, episodic
- Chronic
Types of acute vertigo
- Isolated
- +deafness (peripheral/ ENT)
- +other neurological features (central/ neurology)
What is vestibular neuronitis?
-Acute Unliteral Idiopathic Peripheral Vertigo (AUIPV)
=Vestibular nerve affected before joins cochlear nerve
=Inflammatory/ viral/ vascular
=NOT labyrinthitis (cochlear also damaged)
Clinical presentation of AUIPV
- May come on over a few hours/ may awake with it
- Severe rotatory vertigo, accompanying vertigo disturbances (nausea), exacerbated by head movement (injured vestibular side stimulated)
- Often prostrate for around a week, gradual recovery with good prognosis
- Vertigo on sudden head movements may persist
-Recovery: resolution and central compensation
What is Benign Paroxysm Positional Vertigo?
- BPPV
- Attacks of rotational vertigo
- Generally last 10-20 seconds, may be brief nausea
- Provoked by positional change
What is BPPV caused by?
-Fragments of otoliths in semi-circular canals
=Preceding history of head trauma in some cases
=Good prognosis
=Positional exercises can help
