Transient Loss of Consciousness Flashcards
When does Vasovagal syncope occur?
Nearly always while standing or sitting up erect
Who gets Vasovagal syncope?
Any age or gender
Typically recurrent
Who is Vasovagal syncope MC in?
Elderly & Physically impaired esp if inactive & multiple meds
What are the premonitory sx of vasovagal syncope?
- Light-headed
- Sweating
- Feeling hot or cold
- Pallor
What are the precipitating events of vasovagal syncope?
- Strong emotion
- Pain
- Fatigue
- Coughing
- Urinating
- N/V
- Swallowing
- Defecating
- Hunger
What is the duration of vasovagal syncope?
Seconds to minutes
15% of vasovagal syncope may be assoc w/ brief ___ ___ ____.
Generalized convulsive activity (<1 min)
What are the triggers for vasovagal syncope?
- Prolonged standing
- Hot or crowded cond
- Alcohol
How will the pt look during a syncope event?
- Pale
- Diaphoretic
- Tachycardic or bradycardic
- HOTN
What are the tech features of vasovagl syncope?
Anemia or inadequate hydration
What is the tx for vasovagal syncope?
- Correct underlying physiological ABN
- Recumbent position when warning sx present
- Vasopressors or alpha agonist
- Evaluate meds
What is the hx of Cardiogenic syncope?
Heart dz, palpitation or chest discomfort
What is Cardiogenic syncope NOT related to?
- Pain or emotional triggers
- Unrelated to posture
- LOC rarely results in injury
- Tongue biting & incontinence rare
How long does the post-ictal period last in Cardiogenic syncope?
Brief <5 min
What are the PE findings in Cardiogenic syncope?
Cardiac exam may be normal but MC ABN than w/ non-cardiac syncope
What may or may not be the tech findings of Cardiogenic syncope?
- Cardiomegaly on chest X-ray
- EKG ABN
- 24 hr up to 21day Holter monitor or other more invasive dx test suca as electrophyical studeies, ECHO, Cardiac CT or MRI
What is the tx for Cardiogenic syncope directed at?
Underlying cardiac disturb→ medical or surgical
What is the Management for Cardiogenic syncope?
Cardiac limitations & pt/family education
Who gets seizures?
Any age or gender
What is common hx features of seizures?
- Fhx of seizures
- Head trauma
- Co-morbid neuropsychiatirc hx
What are the PE findings of seizures?
- ABN neuro-psychiatric exam MC than w/ syncope
- Skin lesions common in pts w/ neurocutaneous synd
- Maybe evidence of injuries
What are the tech features of seizures?
- ABN brain imaging (MRI most sensitive) MC than in syncope but normal in >80%
- Electrophalogram may be dx, normal in >80% on any random EEG
What RF do pt with Brainstem TIA have?
- Advanged age
- HTN
- DM
- A-fib
- Hyperlipidemia
- Smoker
- PAD
- CAD
What is the duration of Brainstem TIA?
Minutes to hours
What are the PE findings of Brainstem TIA?
- ABN neuro exam
- Focal brainstem findings
- Crossed motor or sensory changes
- CVD findings
What are the focal brainstem findings?
- CN findings
- Nystagmus
- Ataxia
- Hemiparesis
- Hemisensory loss
What are crossed motor or sensory findings?
Unilateral faciall numbness/weakness w/ contralateral limb numbness/weakness
What are the cerebrovascular dz findings?
Bruits & signs of peripheral vascular dz
What is the cause of brainstem TIA findings?
Transient ischemia of the reticular activating system in the brainstem causes “focal neuro sx” loss of consciousness
What is the hx Hyperventillation/Psychogenic?
- Anixety & hyperventilation
- No hx of pallor or cold sweats
- Perioral tingling & cramping
- Tingling of fingers & hands
- Feeling of impending doom
- Air hunger
What are the PE findings of Hyperventilation?
Signs of anxiety
What is the tx for hyperventilation?
- Rebreathing into a paper bag
- Lying flat
- Anti-anxiety meds
- Mental health couseling
- Pt & family education
- Reassurance
What does hypoglycemia ressemble?
Syncope in terms of pallor, sweating, tachycardia
What is hypoglycemia rare in?
Non diabetics or pt w/ pancreatic neoplasm
What reverses hypoglycemia?
IV or oral glucose
What are the tech features of hypoglycemia?
Very low blood sugars during event
<50mg% or <30mg%
What causes hypoglycemia?
Brain needs O2. glucose, BF & a favorable metabolic millieu to function normally
What is the tx for hypoglycemia?
Adjustment of DM meds
What needs to be intact to maintain consciousness?
Recticular Activating System (RAS)** & Cerebral cortex
Where is the RAS located?
Junction of Pons & Medulla up the brainstem to the Midbrain
What is the blood supply to the brain stem?
Vertebral basilar system
What is the initial component of vasovagal syncope?
Vascular element caused by SNS
