Collapse And Seizures Flashcards
Before the event
Talk me through what happened. What were you doing at the time
Preceding symptoms- how did you feel immediately before, any warning, headache, visual changes, chest pain, palpitations, breathing difficulties
Witnesses- did anyone see it, how did they describe it
During
How did you hit the ground, did you hit your head?
LOC, how long
Seizure- did you have a fit, describe it, whole body shake or just one part
Continence- urine faeces
Tongue- bite, front or side
Complexion- did face colour change before collapse
After
Post ictal- how did you feel immediately after, confused, drizzly, aching muscles
Todd’s paralysis- weakness
Previous episodes- has it happened before, describe the episodes
Systems review
NS- weakness, strange sensations or numbness, how is vision, how is balance
RS/CVS- chest pain, palpitations, cough, SOB
Abdo- pain, bowel habit changed, bleeding from back passage
GUT- blood in urine recently
Constitutional- FWARJNLCI (infection)
Patients perspective
Effects on life and feelings- DRIVING
ICE
Background information
PMH- epilepsy and arrhythmias
DH
FH
SH
Vasovagal syncope (common faint)
3 P’s- posture (prolonged standing), provoking factor, prodromal symptoms
Evoked by string emotion eg. Fear and pain
Nausea pallor feeling hot and sweaty often precede the episode by seconds
Brief LOC, lasts seconds
Limb jerking uncommon and no post ictal state
Cardiogenic syncope
Aortic stenosis/ ACS
Central chest pain and dyspnoea
Stokes Adam attack- collapse without warning, park with a slow/absent pulse and rapid recovery with facial flushing
LOC 10-30 seconds may be due to heart block from MI
Seizure
LOC, fall, limbs go stiff, limbs jerk violently
Aura may precede episode (visual, olfactory, sensory, deja vu)
Bites side of tongue and incontinence
Post ictal state- drowsiness , myalgia, headache, insomnia, a,Jesus
Can last 2-3 minutes
Situational syncope
Micturition (particularly men at night)
Coughing attack may precipitate syncope
Carotid sinus syncope
Turning if head or shaving can lead to a brief LOC
Postural hypotension
Often when patient moves from lying/sitting to standing
Very brief, following a head rush or unsteadiness
Anti cholinergic medications (TCA) or anti HTN may contribute
Investigations
Full cardiovascular and neurological examination
Lying and standing BP
ECG (24-62 hour monitoring)
Bloods- FBC UE troponin
Echocardiogram if cardiogenic cause theorised
CT head first seizure or if neuro signs/worrying features
Management
If seizure;
Refer to first seizure clinic
Advise not to drive and to tell DVLA
Don’t bathe alone, swimming, etc,
Try and get someone to video next event it may help neurologist
If PH;
Review meds, avoid precipitating ones, get up slowly and carefully
If cardiac;
Avoid exercise
Refer to cardiology
Treat underlying cause
