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Transient Loss of Consciousness

Common Causes :
-

vasovagal syncope
cardiac syncope
postural syncope
epileptic seixure
pseudoseizure
hypoglycemia
transient ischemic attack (TIA)

VASOVAGAL - affect all age groups


- triggered by prolonged standing in crowded
SYNCOPE
warm, indoor surroundings ex: school,
churches, hospitals.
- Psychogenic factors,

emotion,

tiredness,

fear, pain (takut lihat blood, jarum, dll.)


- Rarely provoked by micturition and
coughing

1st : Feeling dizzy, hot and cold, sweaty, vision become


blurred and darkened, nearby voices become distant (10-15
seconds, at most few minutes) can be prevented by lying
flat
if not prevented ->syncope (usually <30 detik, not more
than 1 minute)
may continue feel sweaty and nauseated, back to normal

CARDIAC

- in relation to exercise or occur in sitting

SYNCOPE

position or lying or patient with known


cardiac disease
- main causes are arrhythmias : heart block,
SVT, obstruction flow

CEREBROV - uncommon
- main causes are basilar artery insufficiency,

10-15 minutes or less


Sudden onset without any warning
Rapid recovery
Investigation : ECG, cardiac echo
Management : treat underlying cardiac disorder
Sudden

brief

attacks

of

dizziness

and

vertigo,

and

ASCULAR

large vessel occlusive disease, and carotid

SYNCOPE

sinus compression or hypersensitivity


- carotid syncope caused by tigh collar or

sometimes transient symptoms of lower nerve dysfunction

mass in the neck (common in older males


in those taking antihypertensive , ex: BB
POSTURAL - main
causes
are
hypovolemia,

Suspected if the patient with a known risk factor complain

SYNCOPE

lightheadedness or loss of consciousness when standing up

antihypertensive

medications

and

polyneuropathies (in DM)

rapidly which is relieved when either itting or lying down.


Diagnosis : symptomatic drop in systolic BP > 30mmHg on
standing compared to lying
Management : changing or discontinuiting any likely causal
medications, instruction : concerning standing up gradually
and wearing support stocking

HYPERVENT - in
ILATION
SYNCOPE

teenage

young

women,

usually

in

response to stress and anxiety


- caused by over breathing in response to
anxiety

Hyperventilation

->

respi

alkalosis

->

cerebral

vasoconstriction -> light headedness, dyspnea, feeling of


unreality, may proceed to blackouts .
Associated with tingling on the lips, tip of the nose, and
finger tips and rarely muscle twitches of the fingers,
followed by short episode of loss of consciousness, lasting
seconds.

EPILEPTIC

Occur

in

any

SEIZURE

incontinence/tongue

posture,
biting,

sudden
period

onset,

ada

unconsciousness

minutes, recovery slow, postictal confusion last 10-15 mins.


HYPOGLYCE

Frequently

in

diabtetics

MIA

hypoglycemia agents or insulin.

with episodes of confusion, abnormal speech, unusual

Prolonged exercise, fasting, liver disease and

behavior

malignancies

Blood glucose (2.5 mmol/L

including

taking

hepatoma

oral

and

insulinoma
TIA

Caused

by

Feelings of hunger, sweating nervousness and palpitations,

Tx : IV glucose
thromboemboli

arising

from

internal carotid arteris or from heart in AF or


mitral valce disease

Focal neurologic deficit resolves < 24 jam.


Ada risk factors