Pediatric emergency medicine trisk 1510 1510
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It may be difficult to differentiate an epileptic seizure from the convulsions or
posturing that may follow a brief but severe cerebral hypoxic event caused by
vasovagal syncope. An important distinguishing feature is that in the latter, the
patient usually displays a normal orientation after the syncopal event compared to
the more prolonged postictal confusion and lethargy that usually follows a typical
generalized epileptic seizure. Nausea and sweating are also more common with
syncope. Incontinence and fall-induced trauma may be observed in both
conditions and are not discriminatory. A distant stare may precede an atonic
seizure but is not typical of vasovagal syncope. The prodromal symptoms of
vasovagal syncope differ from the aura that may precede a seizure in some
patients. Prolonged clonic seizure activity after the patient is recumbent is not
expected in a syncopal event.
Narcolepsy
Cataplexy, muscle weakness, and collapse in a patient with narcolepsy may
mimic syncope. However, in these patients there are more likely to be disorders
of the sleep–wake cycle, symptoms of daytime somnolence, and sometimes
hallucinations.
Vertebrobasilar Migraine or Transient Ischemic Attacks
In such migraines, symptoms such as tinnitus, vertigo or other aura, and occipital
headache may be observed. However, this constellation of symptoms is not
specific. In vertebrobasilar migraine, as in vertebrobasilar arterial insufficiency
causing transient ischemic attacks, loss of consciousness may be observed.
Psychogenic Causes of Syncope
Hyperventilation and conversion disorder can lead to syncopal events. These
conditions are relatively common in adolescence. Hyperventilation may occur as
part of a panic disorder. Patients may complain of chest tightness, breathlessness,
lightheadedness, palpitations, and dizziness. Syncope-like symptoms due to
conversion disorder occur in the presence of an audience and are not associated
with injury. Episodes tend to last longer than the typical vasovagal syncope and
are not posture dependent. Neurologic and autonomic manifestations are usually
absent.
Orthostatic Intolerance
Syncope attributable to orthostatic hypotension occurs upon assuming an upright
posture (i.e., orthostasis) due to a drop in BP. It is defined as a drop in systolic BP
of ≥20 mm Hg or diastolic BP of ≥10 mm Hg with assumption of an upright
