Abstract
Syncope is a brief loss of consciousness due to sudden, global transient reduction in blood supply to the brain. Presyncope is due to similar causes as syncope; however, patients have transitory altered but not complete loss of consciousness. Characteristic features include loss of consciousness (for syncope) lasting anywhere from a few seconds to a few minutes with no aura or postictal confusion; there are feelings of generalized weakness, lightheadedness or dizziness, profuse diaphoresis, palpitations, and pallor with cold extremities. Minor twitching or trembling, even convulsions, as well as urinary incontinence (rarely) may occur with syncope.
The most important task is to rule out serious causes such as cardiac arrhythmias, myocardial ischemia/infarction, pulmonary embolism, GI bleed with shock, carotid or aortic dissection, intracranial bleeding, and seizures.
During the initial stabilization phase, evaluate for hypotension (including orthostatics) and bradycardia. If consciousness is persistently depressed, manage the patient in the recovery position. The physical examination should exclude neurological focality, signs of meningism, and signs of trauma including those that may be self-inflicted during seizure activity (e.g., tongue biting).
Initial investigations should include CBC, CMP, finger-stick glucose, and an ECG with rhythm strip. Only in cases where a primary neurological cause is suspected, further work-up may include CT/MRI brain, EEG, and carotid ultrasound with cardiac monitoring and a 2-D echocardiogram.
Treatment is guided by the underlying etiology identified.
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References
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Rana, A.Q., Morren, J.A. (2013). Syncope. In: Neurological Emergencies in Clinical Practice. Springer, London. https://doi.org/10.1007/978-1-4471-5191-3_19
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DOI: https://doi.org/10.1007/978-1-4471-5191-3_19
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