- SUNY Stony Brook School of Medicine, Stony Brook, NY 11794, USA
- Winthrop University Hospital, Mineola, NY 11501, USA
Correspondence Address:
Mark Stecker
Winthrop University Hospital, Mineola, NY 11501, USA
DOI:10.4103/2152-7806.157615
Copyright: © 2015 Khan T. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.How to cite this article: Khan T, Stecker M, Stecker M. Evaluating the patient with loss of consciousness. Surg Neurol Int 25-May-2015;6:
How to cite this URL: Khan T, Stecker M, Stecker M. Evaluating the patient with loss of consciousness. Surg Neurol Int 25-May-2015;6:. Available from: http://surgicalneurologyint.com/surgicalint_articles/evaluating-patient-loss-consciousness/
INTRODUCTION
Patients who have had an episode of altered awareness and are subsequently brought to the hospital for evaluation are common[
It is also common for providers to lump all patients with transient alterations of awareness under the diagnosis of syncope. It is thus essential to clearly define the term syncope. The Merriam-Webster Dictionary defines syncope as “loss of consciousness (LOC) resulting from insufficient blood flow to the brain.”[
The differential diagnoses
In order to obtain an optimal history, it is important to be aware of the diagnoses that could potentially cause the patient's symptoms. Soteriades[
Table 1
Causes of syncope from Soteriades[
[
Table 5a
Individual symptoms and the risk of seizure versus nonseizure according to Hoefnagels[
Table 5b
The probability of seizure as a function of various combinations of four symptoms according to Hoefnagels[
Besides the questions shown in Tables
Table 6
The calgary syncope score.[
Physical examination
The physical examination can reveal more about the reasons for a patient's LOC. Overall, the examination is targeted toward finding signs of cardiac disease and any evidence of neurologic illness. Useful physical findings in patients presenting with loss of consciousness. [
Summary
Although there has been much literature dedicated to making the correct diagnosis in a patient who presents with a transientl altered level of consciousness, the concept remains difficult and is strongly dependent upon the provider's skill in obtaining a complete history and physical examination.
References
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3. Grossman SA, Fischer C, Bar JL, Lipsitz LA, Mottley L, Sands K. The yield of head CT in syncope: A pilot study. Intern Emerg Med. 2007. 2: 46-9
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