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Syncope
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Syncope

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  1. Syncope J. Ned Pruitt II, MD Associate Professor of Neurology Medical College of Georgia

  2. Syncope • Syncope – a transient loss of consciousness with a loss of postural tone caused by a brief global reduction or cessation of cerebral blood flow • Causes - cardiac, neurlogic, vascular, and psychiatric

  3. Clinical Manifestations of Syncope • “Dizzyness” or dysequilibrium – visual changes “greying out” - mental clouding – deafness – nausea – loss of postural tone • Rostral to caudal progression • Myoclonus – “jerking” not seizure activity • Rapid recovery of consciousness without a post-ictal confusion or exhaustion • No focal neurologic before or after event

  4. Causes of Syncope • Cardiovascular – • Decreased preload – hypovolemia/hemorrhage, Valsalva manuever • Decreased iontrophy – cardiac ischemia, cardiomyopathy • Dysrhythmia - • Bradycardia - asystole, carotid sinus hypersensitivity, micturtion, defecation • Tachycardia - supraventricular or ventricular

  5. Causes of Syncope • Cardiovascular (cont’d) • Flow obstruction – pulmonary embolism, pulmonary hypertension, aortic stenosis, iodopathic hypertrophic subaortic stenosis, value disease • Tamponade • Anemia

  6. Causes of Syncope • Neurologic • Neurocardiogenic sycope – “the faint” • Vasovagal syncope • Autonomic insufficency • Medications – alpha and beta blockers • Peripheral neuropathy – diabetes, GBS • Adrenal insufficiency • Prolonged bedrest • syrinx

  7. Causes of Syncope Neurologic - (cont’d) • Increased intracranial pressure – SAH, shunt malfunction, obstructive hydrocephalus, venous sinus occlusion • Vertebral artery disease – dissection with embolus, subclavian steal • Hyperventilation

  8. Symptoms of Autonomic Insufficiency • Orthostatic hypotension • “dizzy” with change in position • Dry mouth • Constipation or obstipation • Impotence • Blurred vision

  9. Syncope Workup • History and physical • BP in both arms • BP lying, sitting and standing • ECG, cardiac event monitor or loop recorder • Rarely EEG • MRI and CT of little use if neuro exam is normal

  10. Syncope Treatment • Cardiac – pacemaker, medications if low CO, defibrillator • Removal of offending medications • Treatment of vascular disease • Counciling and recognition – paperbag • Autonomic insufficiency – SSRI, NaCl, midodrine,