Common cerebral histories - Fit/syncope Flashcards
What would you want to know when asking about a fit/fall/syncope?
- Before
- During
- After
What would you ask about seizure/LOC - during the event?
- Duration
- Movements - floppy/stiff/jerking
- Incontinence/tongue biting
- Complexion
What would you ask about seizure/LOC - after the event?
- Amnesia
- Muscle pain
- Confusion/sleepiness
- Injuries
What questions would you want to ask in relation to LOC/seizure on systems enquiry?
- General - fever
- CVS - Palpiations, chest pain, SOB, wheeze, leg swelling
- Neuro - Headache, dizziness, vision, hearing, memory loss, neck stiffness, weakness/wasting, incontinence, numbness
What features associated with Fit/faints/fall may suggest postural hypottension?
- Dizziness +/- LOC on standing from sitting/lying
- Rcent medication change
What features associated with fit/faint/fall would suggest arrythmia as a cause?
- Fall after palpitations/felt strange
- CArdiac history
- Family history
- Occured during exercise or when supine
What features associated with LOC/fits/falls would suggest aortic stenosis?
- Collapse on exertion
- SOB worse on exercise
What features associated with fit/faint/fall would suggest a simple partial seizure?
- Focal motor seizure
- No LOC
What features associated with fit/faint/fall would suggest a complex partial seizure?
Strange actions with impaired awareness
What features associated with fit/faint/fall would suggest a generalised tonic clonic seizure?
- Sudden LOC
- Limbs stiff then jerk
- May become incontinent
- Bite tongue
- Feel awful with myalgia and confusion afterwards
What features associated with fit/faint/fall would suggest a generalised abscence seizure?
Unresponsive stare into space for > 5 seconds
What features associated with fit/faint/fall would suggest a generalised atonic seizure?
All muscles relax and drop to the floor
What features associated with fit/faint/fall would suggest a generalised myoclonic seizure?
Involuntary flexion
What features associated with fit/faint/fall would suggest a generalised tonic seizure?
All muscles become rigid
What features associated with fit/faint/fall would suggest a parkinsons disease?
TETRAD
- Tremor
- Bradykinesia
- Postural instability
- Rigidity
What features associated with fit/faint/fall would suggest a TIA/stroke?
LOC/syncope very uncommon - Focal Neuro symptoms
What features associated with fit/faint/fall would suggest a vasovagal?
- Occurs in response to stimuli - emotion, pain, feat, prolonged standing
- Preceding nausea, pallor, sweat, closing visual fields
- LOC for approx 2 minutes
What are cardiorespiratory causes of a fit/faint/fall?
- Postural hypotension
- Arrythmia
- Aortic stenosis
- HOCM
- Situational syncope
- Carotid sinus hypersensitivity
- Vertebrobasilar insufficiency
- PE
What are neurological causes of fits/faint/falls?
- Seizure
- Parkinson’s disease
- TIa/stroke
- Vasovagal
- Neuropathy
- Intracranial haemorrhage
- Drop attack
What are abdominal cause of fits/faints/seizures?
- Ectopic pregnancy
- Ruptured AAA
What non-cardiovascular/neurological/abdominal causes of fits/faints/falls would you also consider as part of a differential?
- Drugs - alcohol, opiates, other
- Anaemia
- Hypoglycaemia
- Vertigo
- Eyesight problems
- Mechanical/arthritis