Loss of Consciousness (LOC)

Differential Diagnosis:  Recent Hx of a “Spell”

Fell to Floor

Amnesia (without Fall)


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.