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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


Dr Siân Price

Consultant Neurologist, Sheffield Teaching Hospitals

  • 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?
  • 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