CASE 44 - Syncope

Question 1

Do you think I have a brain tumor?

Answer 1

I think it’s unlikely. To make absolutely sure, however, we will do a CT scan, which is a special imaging study of the brain.

That will help us see the structure of the brain and rule out any bleeding or tumor.

Question 2

Specific Qs:

Answer 2

1. Describe what happened.
2. Loss of consciousness before, during, or after the fall.
3. Duration of loss of consciousness.
4. Palpitation before the fall.
5. Sensing something unusual before losing consciousness (sounds, lights, smells etc).
6. Spinning/lightheadedness.
7. Shaking (seizures).
8. Duration of shaking.
9. Bit tongue.
10. Lost control of the bladder.
11. Speech difficulties.
12. Confusion after regaining consciousness.

Question 3

PEx:

Answer 3

1. Head and neck exam ==> Inspection (head, mouth), carotid auscultation and palpation, thyroid exam.
2. CV ==> P + A + Orthostatic VS.
3. Chest ==> A.
4. Extr ==> Palpated peripheral pulses.
5. Neuro ==> Mental status, CNs (including fundoscopic exam), motor exam, DTRs, cerebellar, Romberg test, gait, sensory exam.

Question 4

DDx:

Answer 4

1. Convulsive syncope.
2. Cardiac arrhythmia.
3. Seizure.
4. Vasovagal syncope.
5. Drug-induced orthostatic hypotension.
6. Aortic stenosis.

Question 5

Workup:

Answer 5

1. CBC.
2. Electrolytes.
3. ECG.
4. CT head or MRI brain.
5. EEG.
6. Echocardiography.
7. CXR.
8. Prolactin (measured 30-60min post-seizure).