LOSS OF CONSCIOUSNESS (LOC)

Question 1

26 yo M presents after falling and losing
consciousness at work. He had rhythmic
movements of the limbs, bit his tongue,
and lost control of his bladder. He was
subsequently confused (as witnessed by
his colleagues).

Answer 1

Seizure, grand mal- CBC, electrolytes, glucose
(now called complex tonic-clonic seizure) Urine toxicology
Convulsive syncope EEG
Substance abuse/overdose MRI—brain
Malingering CT—head
Hypoglycemia LP—CSF analysis
ECG

Question 2

55 yo M c/o falling after feeling dizzy
and unsteady. He experienced transient
LOC. He has hypertension and is on
numerous antihypertensive drugs.

Answer 2

Drug-induced orthostatic hypotension (causing Orthostatic vital signs
syncope) CBC
Cardiac arrhythmia Electrolytes
Syncope (vasovagal, other causes) CT—head
Stroke ECG
MI V/Q scan
Pulmonary embolism CT—chest with IV contrast

Question 3

65 yo M presents after falling and losing
consciousness for a few seconds. He
had no warning prior to passing out but
recently had palpitations. His past history
includes coronary artery bypass grafting
(CABG).

Answer 3

Cardiac arrhythmia (causing syncope) ECG
Severe aortic stenosis Holter monitoring
Syncope (other causes) CBC, electrolytes Seizure Glucose
Pulmonary embolism Echocardiography
CT—head