syncope
DESCRIPTION
Syncope. J. Ned Pruitt II, MD Associate Professor of Neurology Medical College of Georgia. 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 - PowerPoint PPT PresentationTRANSCRIPT
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SyncopeSyncope
J. Ned Pruitt II, MD
Associate Professor of Neurology
Medical College of Georgia
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SyncopeSyncope
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
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Clinical Manifestations of Clinical Manifestations of SyncopeSyncope
“Dizzyness” or dysequilibrium – visual changes “greying out” - mental clouding – deafness – nausea – loss of postural tone
Rostral to caudal progression Myoclonus – “jerking” not seizure activityRapid recovery of consciousness without a
post-ictal confusion or exhaustionNo focal neurologic before or after event
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Causes of SyncopeCauses 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
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Causes of SyncopeCauses of Syncope
Cardiovascular (cont’d)– Flow obstruction – pulmonary embolism,
pulmonary hypertension, aortic stenosis, iodopathic hypertrophic subaortic stenosis, value disease
– Tamponade– Anemia
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Causes of SyncopeCauses 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
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Causes of SyncopeCauses 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
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Symptoms of Autonomic Symptoms of Autonomic InsufficiencyInsufficiency
Orthostatic hypotension– “dizzy” with change in position
Dry mouthConstipation or obstipationImpotenceBlurred vision
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Syncope WorkupSyncope Workup
History and physicalBP in both armsBP lying, sitting and standingECG, cardiac event monitor or loop
recorderRarely EEGMRI and CT of little use if neuro exam is
normal
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Syncope TreatmentSyncope Treatment
Cardiac – pacemaker, medications if low CO, defibrillator
Removal of offending medicationsTreatment of vascular diseaseCounciling and recognition – paperbagAutonomic insufficiency – SSRI, NaCl,
midodrine,