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Syncope

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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 ... – PowerPoint PPT presentation

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Title: Syncope


1
Syncope
  • J. Ned Pruitt II, MD
  • Associate Professor of Neurology
  • Medical College of Georgia

2
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
  • Causes - cardiac, neurlogic, vascular, and
    psychiatric

3
Clinical Manifestations of Syncope
  • Dizzyness or dysequilibrium visual changes
    greying out - mental clouding deafness
    nausea loss of postural tone
  • Rostral to caudal progression
  • Myoclonus jerking not seizure activity
  • Rapid recovery of consciousness without a
    post-ictal confusion or exhaustion
  • No focal neurologic before or after event

4
Causes 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

5
Causes of Syncope
  • Cardiovascular (contd)
  • Flow obstruction pulmonary embolism, pulmonary
    hypertension, aortic stenosis, iodopathic
    hypertrophic subaortic stenosis, value disease
  • Tamponade
  • Anemia

6
Causes 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

7
Causes of Syncope
  • Neurologic - (contd)
  • Increased intracranial pressure SAH, shunt
    malfunction, obstructive hydrocephalus, venous
    sinus occlusion
  • Vertebral artery disease dissection with
    embolus, subclavian steal
  • Hyperventilation

8
Symptoms of Autonomic Insufficiency
  • Orthostatic hypotension
  • dizzy with change in position
  • Dry mouth
  • Constipation or obstipation
  • Impotence
  • Blurred vision

9
Syncope Workup
  • History and physical
  • BP in both arms
  • BP lying, sitting and standing
  • ECG, cardiac event monitor or loop recorder
  • Rarely EEG
  • MRI and CT of little use if neuro exam is normal

10
Syncope Treatment
  • Cardiac pacemaker, medications if low CO,
    defibrillator
  • Removal of offending medications
  • Treatment of vascular disease
  • Counciling and recognition paperbag
  • Autonomic insufficiency SSRI, NaCl, midodrine,
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