Seizure, Syncope and Sudden Collapse

Associate Professor Peter Kas presents Seizure, Syncope and Sudden Collapse.

The patient with syncope or presyncope becomes a challenge in the emergency setting. Although this diagnosis is reported to comprise 5% of emergency presentations, it seems like so much more than this.

This lecture looks at the definition of syncope, which comprises three elements:

• a sudden loss of consciousness
• a loss of postural tone
• a complete recovery to baseline

It’s this definition that helps us differentiate syncope from seizure. Beware the bystander accounts of seizure activity as these can be very much mistaken for myoclonic jerking that occurs with a syncopal episode. A prolonged recovery time, usually noted as greater than 5 minutes indicates that the patient may have had a seizure.

The lecture also looks at the causes of syncope and distinguishes the more serious causes In fact if we could ask one question in syncope it would be; Is this a Cardiac cause of Syncope? It appears to place patients in a higher risk group.

The lecture also introduces us to the ‘SYNCOPE PLUS‘ idea:

• Syncope PLUS Headache: was this an Intracranial Haemorrhage?
• Syncope PLUS Shortness of Breath: was this a PE?
• Syncope PLUS Chest Pain: was this a Dissection?
• Syncope PLUS Palpitations: was this an Arrhythmia?
• Syncope PLUS Abdominal Pain: Was this a AAA?

The lecture also looks at the ECG as being one of the most important investigations to help us make the diagnosis and gives examples of all the potential ECG’s that we need to know,  to make the diagnosis.