Download syncope

syncope
Dr M.Jalali
neurologist
Transient loss of con ciousness due
to transient global cerebral
hypoperfusion characterized by:
Rapid onset
Short duration
Spontaneous complete recovery
Conditions incorrectly diagnosed
as syncope:
Disorders with partial or complete LOC but without cerebral
hypoperfusion:
Epilepsy
metabolic disorders including hypoglycemia, hypocapnia
Intoxication
Vertebrobasilar TIA
Disorders without impairment of conciousness
Drop attack
psychogenic
Classification of syncope
-reflex(neurally mediated) syncope
-orthostatic hypotention mediated syncope
-cardiac syncope
Reflex syncope(neurally mediated syncope):
-Vasovagal:
Mediated by emotional:fear,pain,blood phobia
Mediated by orthostatic stress
-Situational:
Cough ,valsava,micturation
-Carotid sinus syncope
Syncope due to orthostatic
hypotension:
Primary autonomic failure:PD,lewy body dementia
Secondary autonomic failure:DM,amyloidosis,spinal
cord injury
Drug induced:vasodilator
Volume depletion:hemorrhage,diarrhea
Cardiac syncope
-Arrhythmia
-Structural disease:pulmonary
emboli,valvular heart disease,cardiac
mass,tamponade,aortic dissection,MI
Initial evaluation of a patient
presenting with transient loss of
conciousness:
Careful hx
Physical exam (orthostatic hypotension)
ECG
Initial evaluation should answer
three key questions:
Is it a syncopal episode or not?
Has the etiological diagnosis been
determined?
Are there data suggestive of a high risk of
cardiovascular events or death?
history
Position:supine,sitting,standing
Activity:rest,exercise,cough,micturtion,swallowing
Predisposing factor:prolonged standing,hot weather
Stimulating factors:fear,severe pain,neck movement
Symptoms prior syncope:N/V,dizziness,sweating,aura,blurred vision
Attack:skin color,LOC duration ,respiration,abnormal
movement,tongue bitting,urinary incontinency
post attack myalgia and headache,injury
Medical history:medication,heart dx,DM,family hx of sudden death
Clinical clue
Reflex syncope:
After pain or fear,prolonged standing,N/V,after eating,pressure on
carotid,hot weather
during or after micturation,cough,defication,swallowing
Orthostatic hypotension:
Postural change,hx of autonomic neuropathy or parkinsonism,anti
hypertensive drugs
Cardiac syncope:
heart dx,palpitation,sudden death family hx,supine position,on
exercise
Situational
Differentiation between
syncope and convulsion
Seizure
syncope
Relation to posture
no
common
Time of day
diurnal or nocturnal
diurnal
Aura or premonitory symptoms
brief
long
Convulsion
common
rare
injury
common
rare
urinary incontinency
common
rare
Tongue biting
common
no
Postictal confusion
common
no
Postictal headache
common
no
Focal neurological signs
common
no
Cardiovascular signs
no
common