Fits / faints / Funny turns
Fits / faints / Funny turns
Paroxysmal Event
DDx (5-25% misdiagnosis)
Hx
FHx: sudden death <30, prolonged QT, cardiomyopathy (cardiac)
Previous episodes, neurological insults, development
Witness
Time
Doing before
Precipitants: dehydration, standing, hunger, heat, pain, stress, micturition, cough, brushing hair, neck extension stretching, weight lifting (syncope)
Exercise (Cardiac syncope i.e. arrhythmia)
sleep deprivation, drug/OH withdrawal (seizure),
illness, injury, ?
start
dizziness/blurred vision/auditory fading (Syncope)
palpitations (cardiac syncope)
autonomic features: pallor clammy (syncope)
Olfactory, gustatory, epigastric rising, dysmnesic (déjà-vu (seizure)
automatisms: lip-smacking, tongue biting (seizure)
LOC or responsive
awake or sleep
Cyanosis
Urination
convulsion: tonic, clonic, focal/generalised
Eyes: open/closed/dev
Duration: 10-30s (syncope), 1-2mins (seizure)
end
Drowsy secs (syncope), mins (seizure) aggressive post
Ex
Infection
Neuro deficit incl GCS
HC
Neurocut
BP
Ix
Video or parent demonstration
ECG (all)
CMP
Prolactin (? utility, up in 100% GTC, 84% complex partial, and 28% of pseudoseizure ie if normal > not GTC)
EEG
MRI / CT
Paroxysmal Event
DDx (5-25% misdiagnosis)
- Seizure
- Syncope: transient loss of consciousness and postural tone caused by global reduction of blood flow to brain
- CAN have clonic/myoclonic jerks (but asynchronous not tonic and start AFTER LOC), incontinence
- Breath-holding aka infantile syncope: stress > (?cries) > holds breath > cyanosis/pale > LOC and floppy > cries > recovers
- can terminate with tonic / clonic episode
- EEG and ECG both slow/stop (i.e. brief asystole)
- Parasomnia: night terrors (pavor nocturnus), sleep walking - NREM S3/4 (1-2hr post sleep), fear, unresponsive arousal, sympathetic drive, amnesia, 1/night, several mins
- Pseudoseizure: wild variable posture with fluctuating jerks, prolonged motionless collapse with eyes shut (NOT in sleep/doesnt comprimise ABCs, Prolactin doesn't rise
- Migraine with brainstem aura
- Complex motor tic
Hx
FHx: sudden death <30, prolonged QT, cardiomyopathy (cardiac)
Previous episodes, neurological insults, development
Witness
Time
Doing before
Precipitants: dehydration, standing, hunger, heat, pain, stress, micturition, cough, brushing hair, neck extension stretching, weight lifting (syncope)
Exercise (Cardiac syncope i.e. arrhythmia)
sleep deprivation, drug/OH withdrawal (seizure),
illness, injury, ?
start
dizziness/blurred vision/auditory fading (Syncope)
palpitations (cardiac syncope)
autonomic features: pallor clammy (syncope)
Olfactory, gustatory, epigastric rising, dysmnesic (déjà-vu (seizure)
automatisms: lip-smacking, tongue biting (seizure)
LOC or responsive
awake or sleep
Cyanosis
Urination
convulsion: tonic, clonic, focal/generalised
Eyes: open/closed/dev
Duration: 10-30s (syncope), 1-2mins (seizure)
end
Drowsy secs (syncope), mins (seizure) aggressive post
Ex
Infection
Neuro deficit incl GCS
HC
Neurocut
BP
Ix
Video or parent demonstration
ECG (all)
CMP
Prolactin (? utility, up in 100% GTC, 84% complex partial, and 28% of pseudoseizure ie if normal > not GTC)
EEG
MRI / CT
- fails to wake up
- focal neurology