Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000071.xml
Semin Neurol 2021; 41(06): 667-672
DOI: 10.1055/s-0041-1726359
DOI: 10.1055/s-0041-1726359
Review Article
Approach to Loss of Consciousness: Distinguishing Epileptic Seizures, Psychogenic Nonepileptic Seizures, and Syncope
Abstract
Transient loss of consciousness (TLOC) is a common emergent neurological issue, which can be attributed to syncope, epileptic seizures, and psychogenic nonepileptic seizures. The purpose of this article is to outline an approach to diagnosing the most common etiologies of TLOC by focusing on the importance of the history and physical examination, as well as targeted diagnostic tests.
Keywords
transient loss of consciousness - loss of consciousness - seizures - syncope - psychogenic nonepileptic seizuresPublication History
Article published online:
26 November 2021
© 2021. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Baron-Esquivias G, Martínez-Alday J, Martín A. et al. Epidemiological characteristics and diagnostic approach in patients admitted to the emergency room for transient loss of consciousness: Group for Syncope Study in the Emergency Room (GESINUR) study. Europace 2010; 12 (06) 869-876
- 2 Reuber M, Chen M, Jamnadas-Khoda J. et al. Value of patient-reported symptoms in the diagnosis of transient loss of consciousness. Neurology 2016; 87 (06) 625-633
- 3 Oto MM. The misdiagnosis of epilepsy: appraising risks and managing uncertainty. Seizure 2017; 44: 143-146
- 4 Chen M, Jamnadas-Khoda J, Broadhurst M. et al. Value of witness observations in the differential diagnosis of transient loss of consciousness. Neurology 2019; 92 (09) e895-e904
- 5 Lown B. The Lost Art of Healing: Practicing Compassion in Medicine. Reprint edition.. Ballantine Books; 1999
- 6 Hampton JR, Harrison MJ, Mitchell JR, Prichard JS, Seymour C. Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients. BMJ 1975; 2 (5969): 486-489
- 7 Peterson MC, Holbrook JH, Von Hales D, Smith NL, Staker LV. Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. West J Med 1992; 156 (02) 163-165
- 8 Tatum WO, Hirsch LJ, Gelfand MA. et al; OSmartViE Investigators. Assessment of the predictive value of outpatient smartphone videos for diagnosis of epileptic seizures. JAMA Neurol 2020; 77 (05) 593-600
- 9 Dugan P, Carlson C, Bluvstein J, Chong DJ, Friedman D, Kirsch HE. EPGP Investigators. Auras in generalized epilepsy. Neurology 2014; 83 (16) 1444-1449
- 10 Lin JT, Ziegler DK, Lai CW, Bayer W. Convulsive syncope in blood donors. Ann Neurol 1982; 11 (05) 525-528
- 11 van Dijk JG, Thijs RD, Benditt DG, Wieling W. A guide to disorders causing transient loss of consciousness: focus on syncope. Nat Rev Neurol 2009; 5 (08) 438-448
- 12 Alsaadi TM, Marquez AV. Psychogenic nonepileptic seizures. Am Fam Physician 2005; 72 (05) 849-856
- 13 Benbadis SR, Wolgamuth BR, Goren H, Brener S, Fouad-Tarazi F. Value of tongue biting in the diagnosis of seizures. Arch Intern Med 1995; 155 (21) 2346-2349
- 14 Brigo F, Nardone R, Ausserer H. et al. The diagnostic value of urinary incontinence in the differential diagnosis of seizures. Seizure 2013; 22 (02) 85-90
- 15 Brigo F, Nardone R, Bongiovanni LG. Value of tongue biting in the differential diagnosis between epileptic seizures and syncope. Seizure 2012; 21 (08) 568-572
- 16 Natt B, Szerlip HM. The lost art of the history and physical. Am J Med Sci 2014; 348 (05) 423-425
- 17 Runser LA, Gauer RL, Houser A. Syncope: evaluation and differential diagnosis. Am Fam Physician 2017; 95 (05) 303-312
- 18 Alapirtti T, Waris M, Fallah M. et al. C-reactive protein and seizures in focal epilepsy: a video-electroencephalographic study. Epilepsia 2012; 53 (05) 790-796
- 19 Sohn HS, Kim SK, Lee SY. Inflammatory markers associated with seizures. Epileptic Disord 2016; 18 (01) 51-57
- 20 Matz O, Heckelmann J, Zechbauer S. et al. Early postictal serum lactate concentrations are superior to serum creatine kinase concentrations in distinguishing generalized tonic-clonic seizures from syncopes. Intern Emerg Med 2018; 13 (05) 749-755
- 21 Matz O, Zdebik C, Zechbauer S. et al. Lactate as a diagnostic marker in transient loss of consciousness. Seizure 2016; 40: 71-75
- 22 Chen DK, So YT, Fisher RS. Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Use of serum prolactin in diagnosing epileptic seizures: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2005; 65 (05) 668-675
- 23 Sarasin FP, Junod AF, Carballo D, Slama S, Unger PF, Louis-Simonet M. Role of echocardiography in the evaluation of syncope: a prospective study. Heart 2002; 88 (04) 363-367
- 24 Ghani AR, Ullah W, Abdullah HMA. et al. The role of echocardiography in diagnostic evaluation of patients with syncope-a retrospective analysis. Am J Cardiovasc Dis 2019; 9 (05) 78-83
- 25 Saal DP, Thijs RD, van Dijk JG. Tilt table testing in neurology and clinical neurophysiology. Clin Neurophysiol 2016; 127 (02) 1022-1030
- 26 Furukawa T. Role of head-up tilt table testing in patients with syncope or transient loss of consciousness. J Arrhythm 2017; 33 (06) 568-571
- 27 Shen WK, Sheldon RS, Benditt DG. et al. 2017 ACC/AHA/HRS Guideline for the evaluation and management of patients with syncope: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2017; 70 (05) 620-663
- 28 LaRoche S, Taylor D, Walter P. Tilt table testing with video EEG monitoring in the evaluation of patients with unexplained loss of consciousness. Clin EEG Neurosci 2011; 42 (03) 202-205
- 29 Benbadis SR. The EEG in nonepileptic seizures. J Clin Neurophysiol 2006; 23 (04) 340-352
- 30 Kocher KE, Meurer WJ, Fazel R, Scott PA, Krumholz HM, Nallamothu BK. National trends in use of computed tomography in the emergency department. Ann Emerg Med 2011; 58 (05) 452-62.e3 , e453
- 31 Ingram WS, Yang J, Wendt III R. et al. The influence of non-rigid anatomy and patient positioning on endoscopy-CT image registration in the head and neck. Med Phys 2017; 44 (08) 4159-4168
- 32 Krumholz A, Wiebe S, Gronseth G. et al; Quality Standards Subcommittee of the American Academy of Neurology, American Epilepsy Society. Practice parameter: evaluating an apparent unprovoked first seizure in adults (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology and the American Epilepsy Society. Neurology 2007; 69 (21) 1996-2007
- 33 Rhoads PS. Sir William Osler: aphorisms from his bedside teachings and writings. Arch Intern Med 1961; 108 (03) 507-508