History taking -- Blackouts.
(loss of consciousness, drop attack, clouding
of the visual field, diplopia, or vertigo)
Introduction
10 points in history: Timing: frequency; duration; time of the day
Is there a warning? eg. an aura preceding the attack
What are the exact circumstances in which they occur
What does the patient look like during an attack (colour, movement)?
What happens during an attack (injury, incontinence)
What is the pulse during the attack
Was the patient confused or sleepy after the attack
How much does the patient remember
Were there accompanying symptoms
Can the patient prevent the attack
H/o smoking and alcohol consumption. Is the patient on any medication for BP? H/o DM, hypoglycaemia, HTN, heart disease? H/o neck stiffness, head injury, fits migraine. Family h/o heart disease.
Epilepsy: tongue biting, occasionally residual paralysis and may be precipitated by TV.
Syncope: rare at night, cannot occur lying down, usually pale during an attack.
Refer: Epilepsy.
DD: Epilepsy, syncope (vaso-vagal), postural hypotension, carotid sinus syndrome, vertebro basilar ischaemia, micturition syncope, cough syncope, hypoglycaemia, raised ICP, anxiety and hyperventilation, alcohol/drug abuse and simulated blackout.
Examination: CVS, CNS & BP: lying and standing.
Tests: U & E, FBC, 24hr ECG & EEG, echocardiogram, CT scan and 2mins hyperventilation.
If epilepsy,advice about jobs and driving. Refer: Epilepsy counseling.