Loss of Consciousness (LOC)

Differential Diagnosis:  Recent Hx of a “Spell”

Fell to Floor Syncope Seizure (generalized) TIA (vertebrobasilar) Head Trauma Conversion Reaction Hyperventilation Intoxication

Amnesia (without Fall) Complex-Partial Seizure Dissociative State Transient Global Amnesia Intoxication

SUMMARY OF WORK-UP

If Fell to (or Awoke on) Floor

1.  If you suspect Syncope:

• Hx suggests vasovagal or orthostatic syncope  →   no tests
• Exertional Syncope   →   EKG, Echocardiogram, ? Stress Test
• Completely spontaneous syncope   →   EKG
  • Implantable Loop Recorder if recurrent faints
  • Cardiology referral if abnormal EKG
• Send to ER if:
  • Same-day exertional syncope
  • Same-day spontaneous syncope + abnormal EKG / cardiac risks

2.  If you suspect Seizure:

• MRI
• EEG (sleep-deprived)
• Neurology referral

3.  If you suspect rare basilar artery TIA:

• MRA / CTA of Head and Neck

4.  If you suspect Psychogenic “Seizures” [& pt./family insist on “tests”]

• Refer to Neuro for decisions re: work-up

If Episode of Amnesia (Without a Fall to Floor)

Can’t distinguish among diagnoses by history (unless Dx “intoxication”):

• MRI
• EEG (sleep-deprived)
• Neurology referral

See postings Loss of Consciousness – 1 and Loss Of Consciousness – 2.