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A18. Examination of the patient after a short-time loss of consciousness
- Differentiate between syncope and neurological causes
- 90% are non-neurological
- Syncope
- Causes
- Cardiac syncope
- Reflex syncope
- Autonomic dysfunction
- Recent change in drugs
- Suspicious features
- Prodromal symptoms
- Blurry vision, sight goes dark
- Sweating
- Lasts seconds
- Patient is oriented immediately after
- Neurological causes
- Almost always seizures
- Suspicious features
- Prodromal symptoms
- Often sudden blackout, no prodromal symptoms
- Aura
- Lasts minutes
- Enuresis
- Muscle soreness
- Bitten tongue on lateral part
- Patient has postictal period of tenebrosity and disorientation after
- History
- Precipitating factor
- Did the patient feel the episode coming?
- What the patient was doing
- How long did the episode last?
- Seconds -> non-neurological
- Minutes -> neurological
- Did the patient bite his tongue?
- Did the patient lose continence?
- Did the patient regain full consciousness immediately or was it gradual?
- A lasting post-ictal confusion is suggestive for a seizure
- In true syncope full consciousness is immediately regained
- Previous loss of consciousness
- Drugs
- Antidiabetics
- Antihypertensives
- Family history
- Previous medical history
- Diabetes
- Hypothyroidism
- Epilepsy
- Known heart problems
- Recent hydration status
- Examination of blood glucose
- Examination of cardiovascular system
- Electrocardiogram
- Heart auscultation
- Turgor
- Neurological examination
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