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Neurological Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Blackouts are transient attacks of loss of consciousness during attacks. Dizziness can mean light-headedness, or vertigo, or a general feeling of unsteadiness. Labyrinthine disorders cause only vertigo, nausea and nystagmus.Brainstem lesions cause diplopia, dysarthria, dysphagia, blurred vision, quadriparesis or cranial nerve palsies in addition to vertigo.Cerebellar lesions may cause unsteadiness, imbalance or ‘walking as if drunk’, but not vertigo.Presyncope comprises light-headedness, faintness, sweating and pallor, which may be relieved by lying flat.Complex partial seizures may be accompanied by déjà vu, altered smell and/or taste, and vivid memories. Stereotyped movements (e.g. lip smacking), automatisms and an open-eyed trance-like state last a few minutes.Absence seizures may be accompanied by fluttering of the eyelids.
First Response
Published in Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan, Diagnosing and Treating Common Problems in Paediatrics, 2017
Michael B O’Neill, Michelle Mary Mcevoy, Alf J Nicholson, Terence Stephenson, Stephanie Ryan
Vasodepressor syncope: (a) reassurance, (b) with presyncope symptoms encourage to cross legs, (c) encourage fluids – avoid dehydration, (d) if simple measures are inadequate and symptoms persist, fludrocortisone is used, although data on effectiveness are limited, (e) most parents will wish for cardiology consultation if symptoms persist.
Practice Paper 1: Answers
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
The term ‘syncope’ describes the sudden loss of consciousness. Presyncope is a feeling of light-headedness. Vasovagal syncope occurs when there is excessive activation of the parasympathetic nervous system in response to certain stimuli, such as heat, fear and stress. The parasympathetic activity causes systemic vasodilatation and bradycardia, which triggers profound hypotension and cerebral hypoperfusion. Collapse is often preceded by a feeling of faintness, nausea, sweating and ringing in the ears. Occasionally, witnesses may describe the patient twitching and a loss of urinary incontinence, which may be confused with seizure activity. Following collapse, cerebral perfusion is restored and recovery is rapid. Situational syncope describes the scenario when vasovagal episodes are triggered by specific actions, such as coughing, urinating or having blood taken.
Antihypertensive treatment and risk factors for syncope in asymptomatic aortic stenosis patients with hypertension
Published in Clinical and Experimental Hypertension, 2022
Meihua Wu, Ping Gu, Qianqiang Cao, Aibin Gong, Wenliang Tan, Dezhi Hong
HTN was defined as a blood pressure >140/90 mmHg on at least two occasions or a history of HTN with normal BP on treatment. Syncope was defined as transient loss of consciousness characterized by rapid onset, short duration, and spontaneous complete recovery (7). In addition, presyncope is described as a state that resembles the prodrome of syncope but which is not followed by loss of consciousness in the guideline (7). In the present study, syncope, including presyncope, was diagnosed by two physicians on the basis of medical records data. Syncopal episodes, diagnosed as neurally mediated syncope and consequential orthostatic hypotension, were included in the definition of syncope in patients with AS because of the possibility that AS triggers or potentiates a reflex mechanism.
Systemic manifestations of Ehlers-Danlos syndrome
Published in Baylor University Medical Center Proceedings, 2021
Bo Song, Peter Yeh, John Harrell
About 30% of patients in this study had been diagnosed with at least one cardiac condition, the most common being arrhythmia (23%), aortic root dilatation (15%), and valvular anomalies (9%). Similarly, Antani et al reported 34% of patients with diagnosed cardiac anomalies.23 While cardiac conditions are known to be highly associated with disorders of hypermobility due to collagen abnormalities in the vasculature, there is a lack of studies reporting prevalence. Of note, EDS patients are also at risk for other complications including aortic regurgitation, aortic root dilation, valvular anomalies, and Raynaud phenomenon.4 Insidious symptoms such as chest discomfort, presyncope, and palpitations should be thoroughly worked up, as they may be life-threatening indications of mitral valve prolapse.4
Predictors of Fear of Falling among Iranian Older Adults with Hip Fracture and Controls
Published in Clinical Gerontologist, 2020
Robabeh Soleimani, Mir Mohammad Jalali, Ahmad-Reza Mirbolook
Blood pressure was measured in all subjects while the subject was in a supine position and again after the subject stood. If there was orthostatic hypotension, history of arrhythmias and myocardial infarction, or subjects described his/her sensation as presyncope, cardiovascular dizziness was considered. Visual acuity was measured in both eyes of participants using a retroilluminated Snellen chart at a distance of 4 m. Moderate visual impairment was defined as presenting visual acuity worse than 6/18 to 6/60 in the better-seeing eye. In this study, visual problem was considered as moderate visual impairment and blindness. Mental status was assessed using Mini-Mental State Examination (MMSE) which is a brief 30-point questionnaire test that assesses five domains: orientation, working memory, attention, delayed memory, and language. It was translated into Persian and has shown good construct validity, high test-retest and inter-rater reliability (Ansari, Naghdi, Hasson, Valizadeh, & Jalaie, 2010; Rashedi, Rezaei, & Gharib, 2014). Severe memory impairment was considered if MMSE score was less than 18.