Multiple Sclerosis

Syncope is defined as a brief loss of consciousness, often involving a fall, due to transient cerebral ischemia or hypoxia (see Table 25, p. 374 for potential causes). In 45 % of cases, the cause can be determined from the history and physical examination. Important anamnestic clues include triggers such as excitement or anxiety, precipitating situations (blood drawing, prolonged standing, urination, coughing fits, pain), heart disease, mental illness (generalized anxiety disorder, depression, somatization disorders), and medications. The patient should be evaluated for possible blood pressure abnormalities and for cardiac or neurological disorders (p. 148). EEG yields the diagnosis in only about 2% of cases. Only rare cases of syncope are due to TIA (p. 166). Syncope clinically resembles an epileptic seizure in some ways, but differs in others (see table, below).

Clinical Feature

Syncope

Epileptic Seizure

Triggers

Common

No

Time of day

Mostly diurnal; does not awaken patient from sleep

Day or night; awakens patient from sleep

Skin coloration

Pale

Cyanotic or normal

Premonitory symptoms

Tinnitus, visual blurring or blackout, feeling faint, lightheadedness

None or aura

Type of fall

Collapse or fall over stiffly (often backwards)

Fall over stiffly

Duration

Usually < 30 seconds

1-3 minutes or longer

Abnormal movements (myoclonus)

Frequent, arrhythmic, multifocal to generalized, last < 30 seconds

Always generalized, 1-2 minutes

Eyes

Open

Closed

Urinary incontinence

Occasional

Common

Postictal confusion

Brief or absent

Longer-lasting

Tongue-biting

Occasional

Common

Prolactin, creatine kinase

Normal

Elevated

Typical EEG changes

Absent

Common

Focal neurological deficit

Absent

Occasional

Multiple Sclerosis
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