Collapse Flashcards
What are the possible differential diagnosis of collapse?
epilepsy syncope psychogenic attacks TIA/stroke Migraine Narcolepsy Hypoglycaemia infection hyper-somnolence/OSA inner ear pathology/BPPV
What are the types of syncopes?
neurally mediated syncope
cardiac syncope
perfusion failure
What are the types of neurally mediated syncope?
1) vasovagal
2) carotid sinus syncope (caused my stimulation of baroreceptors)
3) situational syncope (brought on by urinating or taking BP)
4) valsalva
What are the types of cardiac syncope?
1) arrhythmias (brady & tacchy)
2) valvular disease
3) cardiomyopathies
4) shunts
What are the types of perfusion failure
1) orthostatic hypotension (drugs, diabetes or Parkinson’s)
2) hypovolaemia
3) autonomic failure
What are the types of psychogenic attacks?
- Panic attack
- Night terror
- Breath holding
- Non-epileptic events
How are blackouts diagnosed?
History
- patient + witnesses
- before, during & after event
Examination
- CV (HR, BP sitting + standing & praecordium)
- General
- Neurological (don’t often find anything, only ever really find brain tumour)
What investigations are important to do when diagnosing blackouts?
1) ECG/24 hr tape (Holter monitor)
2) Carotid Sinus massage
3) tilt table
4) ECHO
5) MRI head
6) EEG
what is trifasicular block?
block in all three pathways of conduction (increasing risk of arrhythmias)
What exacerbates sleep paralysis?
- stress, excessive sleepiness, jet lag
What associated symptoms come along with sleep paralysis?
1) associated hallucinations
2) feel like not in your body
What causes sleep paralysis?
waking during your REM sleep usually only lasts a few seconds (body usually paralysed during REM period so don’t act out vivid dreams)
What other symptoms typically come along with narcolepsy?
- cataplexy
- sleep paralysis
- hypnagogic hallucinations
What deficiency is associated with narcolepsy?
hypocretin
What are symptoms of Klein-levin syndrome?
- persistance episodic hypersomnia
- mood changes
- hyperphagia
- hyper-sexuality
What is the treatment for cardiac syncope?
pacemaker
How can vasovagal and cardiac syncope be distinguished?
Vasovagal - onset gradual, commonly nausea in prodome, fatigue for minutes to hours
Cardiac - onset sudden, no prodomal symptoms, no fatigue
What is hyper somnolence?
excessive sleepiness
What are the symptoms of OSA?
- daytime somnolence
- waking up gasping
- poor memory + conc
- headaches
- nocturia
- associated with other cardiac disorders
How can epileptic and psychogenic non-epileptic seizures be distinguished?
PNES - onset gradual, no tongue biting, undulating (waves) motor movement, closed eyelids, no cyanosis, back arching common
ES - sudden onset, tongue biting, no undulating movements, eyelids open usually, cyanosis
How does frontal lobe epilepsy present?
- conscious seizures
- present like non-epileptic/dissociative seizures
- can diagnose with EEG during seizure
