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“TOP TIPS”- BLACKOUTS. Dr Siân Price Consultant Neurologist, Sheffield Teaching Hospitals. Blackouts. What do they mean? Take a detailed History Witness account Loss of consciousness? Loss of awareness? Something else? Sleep? Dizzy? Visual loss? NICE Guidelines.

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“TOP TIPS”- BLACKOUTS

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Top tips blackouts

“TOP TIPS”- BLACKOUTS

Dr Siân Price

Consultant Neurologist, Sheffield Teaching Hospitals


Blackouts

Blackouts

  • What do they mean?

  • Take a detailed History

  • Witness account

  • Loss of consciousness?

  • Loss of awareness?

  • Something else? Sleep? Dizzy? Visual loss?

  • NICE Guidelines


Loss of consciousness syncope

Loss of consciousness -Syncope

  • Hot, lightheaded. Standing, grey out of vision and fading of hearing, floppy to floor, often pale. Rapid recovery ( if lying), brief <2mins. May twitch a bit. Re-faint on re-standing?, hearing back first.

  • Clear provocation and a one off, examine, postural BP, ECG and safety advice.

  • No clear provocation, recurrent. As above and consider bloods FBC, U+E, Glucose, 9am cortisol. If ECG abnormal or “red flags” refer to cardiology. If significant postural drop consider referral to syncope clinic ( or endocrine if results suggest Addison's)


Loss of consciousness refer to cardiology

Loss of consciousness- refer to cardiology?

  • Red Flags

  • Family history of sudden death

  • Age >65

  • Chest pain, palpitations, exercise induced or sitting with light headed feeling or syncope.

  • Prolonged recovery?

  • Abnormal ECG ( QTc?), arrhythmia?, (heart block, WPW, LGL)

  • Murmur, ischaemic heart disease or cardiac failure

  • Consider echocardiogram and 24 hour tape


Loss of consciousness refer to neurology

Loss of consciousness- Refer to Neurology

  • Epilepsy?

  • Possible status epilepticus ? 999, Neurology afterwards.

  • At start :- Warning?, Automatisms? Posturing?

  • Stiff, noisy breathing, odd colour ( desaturating), jerking, eyes often open, may deviate.

  • Prolonged post ictal phase and confusion

  • Bite is usually side tongue, (wetting only means loss of consciousness).

  • Mixed type of attacks

  • Stop and stare?

  • Vacant with automatisms and or confusion

  • Myoclonic jerks

  • Odd blackouts ? Fits or not?


Loss of consciousness no markers or witnesses

Loss of consciousness- No markers or witnesses

  • Known heart disease refer to cardiology

  • Otherwise refer to Neurology


Loss of awareness refer to neurology or peads if 16

Loss of awareness- Refer to Neurology? ( or Peads if <16)

  • Brief blanking+/- myoclonic jerks

  • With automatisms, confusion, refer to Neurology

  • Could it be psycogenic?


Remember

Remember

  • Can have twitching with syncope

  • Fits with headache and fever- encephalitis?

  • More brain tumours present with fits than headache

  • Around half of people having one fit will get more. 1 in 100 or so will have a fit

  • High level initial incorrect diagnosis- always be prepared to think again.

  • Always remember safety ( including for syncope) and driving advice


Rotherham neurology

Rotherham Neurology

  • Outreach from Sheffield

  • Although 4 consultants visiting we only make about 1 and a bit FTE ( Siân Price, Ralf Lindert, Siva Nair, Danute Kucinskiene ( locum)

  • Specialist Nurses outreach from Sheffield too ( Epilepsy, MS, Parkinson’s ( separate from Elderly med), do clinics at Rotherham.

  • Some specialty services and tests done in Sheffield. We have no Rotherham beds but see ward referrals.

  • 2 WW via Sheffield

  • THANK YOU


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