CHAPTER 8 Episodic Loss of Consciousness（第八章情景意识丧失）.pdf

Essentials of Clinical Neurology: Neurology History and Examination 8-1 LA Weisberg, C Garcia, R Strub /neurolect/ CHAPTER 8 Episodic Loss of Consciousness DEFINITION AND INCIDENCE Syncope is the cause of 3% of emergency room visits and 6% of general medical hospital admissions. The term “faintness” includes the sensations of lightheadedness, dizziness, and weakness. Syncope literally means “a cutting short.” It is defined as a sudden, brief loss of consciousness and postural tone. It may develop suddenly without warning or be preceded by presyncopal faintness. At onset, the patient is in standing or sitting position, but syncope of cardiac origin may be exception. There is immediate spontaneous recovery after the unconsciousness. There is not postepisode confusion, although patients can briefly appear dazed. Syncope can be experienced by normal subjects when transient reversible decreased cerebral blood flow or metabolism occurs. The majority of attacks are benign due to altered reflexes affecting cardiac rate and vascular tone and less commonly due to severe cardiac disturbance; however, trauma can result from falls due to syncope, especially in elderly patients. Syncope occurs in 7% of elderly patients and recurs in 30%. Recurrent syncope may lead to traumatic injuries; syncope occurring while driving may lead to serious accidents. The mechanism of syncope and patient outcome are closely linked. In some patients, no cause is delineated despite complete medical cardiac and neurological evaluation. If the cause is cardiac (arrhythmias, valvular, cardiomyopathy), sudden death can occur in 20% of patients. Syncope should be taken seriously in elderly patients because survival rate is reduced even if attack is not of cardiac origin. HISTORY The patient and observers should be carefully questioned regarding: Precipitating factors: emotional stress, fasting state