Transient loss of consciousness: The value of the history for distinguishing seizure from syncope

Abstract

We studied 94 consecutive patients (age 15 or over) to investigate which aspects of the history and clinical findings help to distinguish seizures from syncope and related conditions. Clonic movements or automatism observed by an eyewitness classified an event as a seizure. The seizure group consisted of 41 patients and the syncope group of 53 patients. The likelihood ratio was used to calculate the predictive power of single findings and logistic regression to analyse combinations of findings. The best discriminatory finding was orientation immediately after the event according to the eyewitness and the age of the patient in the absence of an eyewitness report (P less than 0.001). We found a seizure five times more likely than syncope if the patient was disoriented after the event and three times more likely if the patient was less than 45 years of age. Nausea or sweating before the event were useful to exclude a seizure. Incontinence and trauma were not discriminative findings.

Influence of age and gender on the occurrence and presentation of reflex syncope

“…Urinary incontinence was present in 19.1% of our patients with reflex syncope, confirming earlier findings that urinary incontinence provides no additional evidence for or against the diagnosis of a seizure [15]. The duration of the TLOC was <5 minutes in 73.7% of the subjects in our study.…”

“…The duration of the TLOC was <5 minutes in 73.7% of the subjects in our study. Although Hoefnagels et al [15] suggested that a duration of loss of consciousness of >5 minutes and postictal confusion are suggestive of epilepsy, 13.5% of our patients with reflex syncope suffered from prolonged loss of consciousness and postictal confusion was observed in 10% of our patients with reflex syncope. Prolonged periods of unconsciousness or postictal confusion ( ‡5 minutes) in syncope patients may be explained by continuing hypotension, for instance, when remaining in an upright position during or after the episode.…”

“…j Key words syncope AE diagnosis AE age distribution AE sex AE signs and symptoms syncope [2,15,27]. Therefore, knowledge about the occurrence of triggers, signs, and symptoms provides important background information for physicians to optimize and personalize their diagnostic strategy.…”

Transient loss of consciousness as reason for admission to primary health care emergency room

“…In particular, differential diagnosis between seizures and syncope attacks may be difficult (7,9). Nonetheless, history, physical examination and electrocardiography have a combined diagnostic yield of 50% in the assessment of syncope (10).…”

“…Loss of consciousness was classified as seizure (seizure group) or syncope attack and related disorder (syncope group) on the basis of history and clinical examination following previously published principles (7). A seizure had to include repetitive tonic and/or clonic movements or automatisms and the diagnosis was supported by blue face, frothing at the mouth and disorientation or sleepiness after the event.…”