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What is not?

 Impossible is not a fact, its an opinion 


May 16, 2010 by drsalman

Case Sheet

A 50 year old male brought into office by his wife who noticed him having a episode of blackout during shopping grocery for his home where he won a lottery of 10 lakh rupees.Patient went to buy food items for his home along with his wife to nearby grocery store when he was told that he had won 10 lakhs rupees for the lottery ticket which he purchased last month .His wife noticed him describing him telling that he is having giddiness,nausea, ringing sensation in ears in the grocery store.Then patients body became pale and he fell on the ground followed by abrief contraction of his upper and lower limb muscles.This episode lasted for about 1 minutes and the patient slowly regained his consciousness over few more minutes.Patient is now back to normal and does not complain of any headache ,weakness,tingling,confusion,memory loss,chest pain,palpitations,seating,blurring of vision.Patients maternal aunt has history of epilepsy and his father is suffering from CAD,HTN.Patient is known case of Major depression on antidepressents. Patient never had similar complaints in past.Patient is a chronic smoker and works as school van driver.

   On examination patient is right handed with no pallor,icterus,cyanosis,clubbing,pedal edema.

  BP:122/80 mmHg supine:100/56 mmHg Standing

  PR:78/min Supine: 98/Min Standing

 Temp:97.8 F


       Patients nervous system shows no abnormalities.

Case Discussion: 

Neurocardiogenic/Vasovagal:Provoked by emotions,pain fear,longstanding,deep breaths/vasalva maneuver.

Carotid sinus Hypersensitivity;Due to carotid sinus hypersensitivityIt can be 1Cardioinhibitory 2 Vasodepressor

Cardioinhibotory:Blocked by atropine

Vasodepressor:Blocked by epinephrine

Orthostatic:Due to orthostasis.Can be 1. Hyperadrenergic 2.ANS Dysfunction

Hyperadrenergic:Volume depletion,Venous pooling

ANS Dysfunction:Vasoactive/Antidepressent medications




Precipitated by emotions,Longstanding,Fear:50

Aura :

Abnormal visison 60

Giddiness/Fading of vision 60

nausea and vomiting 60

salivation 60

Dration of Episode:

Less than 1 minute60

1-10 Minutes  20

Morethan 10 minutes 10

Pallor during episode 50

Facial flushing 30

Crying or talking during episode -10

Cyanosis during episode 05

Tongue bite during episode 10

Bowel or Bladder incontinence duringepisode 05

Injury during episode 05

Post ictal cofusion 05

Postictal paralysis -10

Post ictal muscle pain 10

Tonic contactions 30

Clonus 30

H/O CAD:20

H/O Arrythmias:20

H/O othostatic Hypotension:20

H/O vasodilators20

H/O  Diuretics20

H/O  Antiarrythmics20

Abnormal EKG 20

Normal EKG 10

If Vasovagal/Neurocardiogenic syncope the give Fludrocortisone/Midodrine/Diisopyramid/Theophilline/16 oz water

If Orthostatic then Volume relete/Fludrocortisone/Midrodrine.

If cardiac causes then correct cardiac cause



What is the diagnosis?

What is sycope??

What are causes of syncope??

What are types of syncope??

How will you differentiate syncope from Seizure??

How will you confirm diagnosis in this case


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