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Is there a history of drug or alcohol ingestion? This is a very important question to ask, as many cases of coma are due to acute alcohol intoxication, delirium tremens, opium poisoning, barbiturate poisoning, and other toxic ... DIAGNOSTIC WORKUP
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...
Is there associated fever? Delirium with fever may simply indicate a self-limited infectious process, but it should bring to mind encephalitis and meningitis as well as cerebral abscess and cerebral hemorrhage.
Is there a history of trauma? A ... DIAGNOSTIC WORKUP
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...
Is it true vertigo? True vertigo is characterized by the fact that the subject feels he or his environment is turning. One other form of true vertigo is lateral pulsion, in which the subject feels as if he is moving to the left or ... DIAGNOSTIC WORKUP
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...
Are there convulsive movements or incontinence? The presence of convulsive movements should suggest convulsions, and the differential diagnosis of this is discussed on
page 88
.
... DIAGNOSTIC WORKUP
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...
A subjective sensory phenomenon that may involve any of the five senses, such as visual auras (often described as flashing lights), sensory auras (paresthesias), or auditory auras. Other auras may be described as dreamlike or déjà vu sensations, or odd odors. The type of symptom... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
An acute confusional state caused by a disturbance in global cortical function. Features include disturbance of consciousness, change in cognition, fluctuations of symptoms, and evidence that the condition is secondary to an underlying medical condition. Frequently, multiple... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Syncope is often referred to by patients as “fainting” and is defined as a loss of postural tone and consciousness. Syncope usually lasts for brief periods of a few minutes. Longer periods are of more concern, because of the... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Dizziness/lightheadedness, a sensation of nearly losing consciousness, must be distinguished from vertigo, a sense of impulsion (spinning), either of the environment or of the patient. Dizziness/lightheadedness usually results from a decrease in cerebral blood... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Coma is a state of total unawareness of the self and the environment. There is no eye opening or response to voice or painful stimuli. Coma can be due to dysfunction of either bilateral cerebral cortex or the reticular activating system in the brainstem or both combined. Locating the lesion... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Delirium is an alteration in consciousness that can be associated with hallucinations, disorientation, and delusions. Normal thought processes are altered, including judgment, and rational behavior may be lost. Causes are typically metabolic derangements, acute... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Vertigo is an illusion of movement (usually rotatory) due to an acute imbalance of tonic vestibular activity. Symptoms of vertigo are nonspecific and occur when there is a disturbance anywhere in the peripheral or central vestibular system. Determining the site of the... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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...
Syncope is temporary loss of consciousness and muscle tone due to decreased cerebral blood flow. It is otherwise known as fainting or blackout. Syncope is a common pediatric problem that, in contrast to that in adults, usually has a benign etiology.... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... The differential diagnosis of delirium is very similar to that for coma and one finds the mnemonic VINDICATE useful in this regard.
V—Vascular disorders of the brain including hemorrhage, embolism, thrombosis, and arteriosclerosis may cause delirium.
... READ EXCERPTS »
... Dizziness may mean true vertigo, which is a hallucination of movement of the patient or his environment, or light-headedness, which is a feeling that one is going to faint (and sometimes does). The causes of light-headedness are developed under the section
... READ EXCERPTS »
... The differential of syncope or a brief loss of consciousness is best developed with the use of physiology and, to a lesser extent, anatomy. Like convulsions (see page 128), syncope is due to a diminished supply of oxygen and glucose in the brain cell.
... READ EXCERPTS »
... Somnolence is a deep sleep from which the patient can be aroused. Coma is an unconscious state from which the patient cannot be aroused. Because somnolence may be simply an early stage of coma, its etiologies are almost all identical to the etiologies of coma. The few exceptions are
... READ EXCERPTS »
... An aura is a sensory or motor phenomenon, idea, or emotion that marks the initial stage of a seizure or the approach of a classic migraine headache. Auras may be classified as cognitive, affective, psychosensory, or psychomotor. (See Recognizing types of auras... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pictures
... READ EXCERPTS »
... A common symptom, dizziness is a sensation of imbalance or faintness, sometimes associated with giddiness, weakness, confusion, and blurred or double vision. Episodes of dizziness are usually brief; they may be mild or severe with an abrupt or a gradual onset. Dizziness may be... History and physical examination ... Medical causes ... Other causes ... Special considerations
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... A decrease in the level of consciousness (LOC), from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also result from... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... Vertigo is an illusion of movement in which the patient feels that he’s revolving in space (subjective vertigo) or that his surroundings are revolving around him (objective vertigo). He may complain of feeling pulled sideways, as though drawn by a magnet. ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
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... A common neurologic sign, syncope (or fainting) refers to a transient loss of consciousness associated with impaired cerebral blood supply or cerebral hypoxia. It usually occurs abruptly and lasts for seconds to minutes. An episode of syncope usually starts as a... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
... READ EXCERPTS »
... Neurologic or Mechanical Causes, or Both
Mediated by vagal stimulation or autonomic insufficiency, or both
Vasovagal reaction (often associated with strong emotion or pain)
... READ EXCERPTS »
... Dizziness
Hyperventilation
Anxiety, psychosomatic causes
Hypoxia
Anemia
Visual disturbances
Incorrect
... READ EXCERPTS »
... Usually No Lateralizing Signs, Normal Brainstem Reflexes
Drug withdrawal after chronic intoxication, especially
Alcohol
Barbiturates
... READ EXCERPTS »
... An aura is a sensory or motor phenomenon, idea, or emotion that marks the initial stage of a seizure or the approach of a classic migraine headache. Auras may be classified as cognitive, affective, psychosensory, or psychomotor. (See ... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... A common symptom, dizziness is a sensation of imbalance or faintness, sometimes associated with giddiness, weakness, confusion, and blurred or double vision. Episodes of dizziness are usually brief; they may be mild or severe with an abrupt or... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling
... READ EXCERPTS »
... A decrease in level of consciousness (LOC), from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also result from a metabolic, GI... Emergency Interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
... READ EXCERPTS »
... Vertigo is an illusion of movement in which the patient feels that he’s revolving in space (subjective vertigo) or that his surroundings are revolving around him (objective vertigo). He may complain of feeling pulled sideways, as though drawn... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
... READ EXCERPTS »
... A common neurologic sign, syncope (or fainting) refers to transient loss of consciousness associated with impaired cerebral blood supply or cerebral hypoxia. It usually occurs abruptly and lasts for seconds to minutes. An episode of syncope usually starts as a feeling... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling
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... Anne Cather Cutlip
Coma represents a state of unarousable unresponsiveness in which the patient has no evidence of self or environmental awareness (1).
Approach. A patient presenting with coma should be considered a medical... History ... Physical examination ... Testing ... Diagnostic assessment.
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... Linda P. Shields
Delirium, as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th edition criterion (1), is a condition involving an acute confusional state recognized by the patient’s change... Approach. ... History ... Physical examination. ... Testing ... Diagnostic assessment.
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... John Muench
Dizziness is a disturbance in a patient’s subjective sensation of relationship to space. It can be the clinical presentation for many different diagnoses. It is the 15th most common reason for all visits to primary care... Approach ... History. ... Physical examination. ... Testing ... Diagnostic assessment
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... Frank S. Celestino
Dizziness accounts for 1% to 2% of all office visits, 7% of visits by patients aged more than 80 years and 20% to 25% of all non–pain-related emergency room visits (1–3). Dizziness and vertigo... Approach ... History ... Physical examination (PE) ... Testing ... Diagnostic assessment
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... James C. Chesnutt
Syncope is a common and concerning medical problem, which accounts for 3% of emergency room visits and up to 6% of hospital admissions. Although the cause of syncope can be life-threatening (e.g., ventricular... Approach. ... History ... Physical examination ... Testing. ... Diagnostic assessment. ... Pictures
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... Differential Overview
❑ Alcohol intoxication
❑ Drug overdose
❑ Hypoglycemia
❑ Metabolic acidosis ... Diagnostic Approach ... Clinical Findings ... Pictures
... READ EXCERPTS »
... Differential Overview
Vertigo
❑ Benign paroxysmal positional vertigo
❑ Vestibular neuronitis
❑ Toxic labyrinthitis ... Diagnostic Approach ... Clinical Findings ... Pictures
... READ EXCERPTS »
... Differential Overview
Orthostatic/Autonomic
❑ Neurally mediated hypotension
❑ Volume depletion
❑ Cough syncope ... Diagnostic Approach ... Clinical Findings
... READ EXCERPTS »
... Differential Overview
Systemic
❑ Drugs/toxins
❑ Sepsis
❑ Hypoglycemia
❑... Diagnostic Approach ... Clinical Findings ... Pictures
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... A common symptom, dizziness is a sensation of imbalance or faintness, sometimes associated with giddiness, weakness, confusion, and blurred or double vision. Episodes of dizziness are usually brief; they may be mild or severe with abrupt or gradual onset. Dizziness may be... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A decrease in level of consciousness (LOC), from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also result from a metabolic, GI... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A common neurologic sign, syncope (or fainting) refers to transient loss of consciousness associated with impaired cerebral blood supply or cerebral hypoxia. It usually occurs abruptly and lasts for seconds to minutes. An episode of syncope usually starts as a feeling of light-headedness... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... An aura is a sensory or motor phenomenon, idea, or emotion that marks the initial stage of a seizure or the approach of a classic migraine headache. Auras may be classified as cognitive, affective, psychosensory, or psychomotor. (See Recognizing types of auras.) ... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A common symptom, dizziness is a sensation of imbalance or faintness, sometimes associated with giddiness, weakness, confusion, and blurred or double vision. Episodes of dizziness are usually brief; they may be mild or severe with abrupt or gradual... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A decrease in level of consciousness (LOC), which can range from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also result from metabolic, GI... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Vertigo is an illusion of movement in which the patient feels that he’s revolving in space (subjective vertigo) or that his surroundings are revolving around him (objective vertigo). He may complain of feeling as if he’s being pulled... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... A common neurologic sign, syncope (or fainting) refers to transient loss of consciousness associated with impaired cerebral blood supply or cerebral hypoxia. It usually occurs abruptly and lasts for seconds to minutes. An episode of syncope usually starts as a... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Vertigois a disturbance of spatial orientation in which individuals havethe sensation that they or their surroundings are moving. Abnormalvestibular function, either in the peripheral or central nervoussystem, produces vertigo. Peripheral vestibular system... Principal Causes of Vertigo ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
... READ EXCERPTS »
...Syncope is a transient loss of consciousnessand postural tone usually produced by impaired cerebral blood flow.Generally, a syncopal episode in childhood is a benign isolatedevent; however, some causes can be life threatening. Because dizzinessoften precedes syncope, it is also discussed in... Principal Causes of Syncope and Dizziness ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
... READ EXCERPTS »
... An aura is a sensory or motor phenomenon, idea, or emotion that marks the initial stage of a seizure or the approach of a classic migraine headache. Auras may be classified as cognitive, affective, psychosensory, or psychomotor. (See Recognizing... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A common symptom, dizziness is a sensation of imbalance or faintness, sometimes associated with giddiness, weakness, confusion, and blurred or double vision. Episodes of dizziness are usually brief; they may be mild or severe with an abrupt or a gradual onset.... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... A decrease in the level of consciousness (LOC), from lethargy to stupor to coma, usually results from a neurologic disorder and may signal a life-threatening complication, such as hemorrhage, trauma, or cerebral edema. However, this sign can also result from a... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Vertigo is an illusion of movement in which the patient feels that he's revolving in space (subjective vertigo) or that his surroundings are revolving around him (objective vertigo). He may complain of feeling pulled sideways, as though drawn by a... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... A common neurologic sign, syncope (or fainting) refers to a transient loss of consciousness associated with impaired cerebral blood supply or cerebral hypoxia. It usually occurs abruptly and lasts for seconds to minutes. An episode of syncope usually starts as a feeling of light-headedness... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
...
The differential diagnosis of delirium is very similar to that for
coma, and one finds the mnemonic VINDICATE useful in this regard.
V—Vascular disorders of the brain including hemorrhage, embolism,
thrombosis, and
... READ EXCERPTS »
...
Dizziness may mean true vertigo, which is a hallucination of movement
of the patient or his environment, or lightheadedness, which is a feeling
that one is going to faint (and sometimes does). The causes of
lightheadedness... Pictures
... READ EXCERPTS »
...
Somnolence is a deep sleep from which the patient can be aroused. Coma
is an unconscious state from which the patient cannot be aroused. Because
somnolence may be simply an early stage of coma, its etiologies are almost
all identical to the... Pictures
... READ EXCERPTS »
...
The differential of syncope or a brief loss of consciousness is best
developed with the use of physiology and, to a lesser extent,
anatomy. Like convulsions , syncope is due to a diminished supply of oxygen and glucose
in the brain cell.... Pictures
... READ EXCERPTS »
... Phillip Spandorfer
Approach to the Patient with Syncope
I. Definition of the Complaint
Syncope is generally thought of as a temporary, but sudden, loss of
... Pictures
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... Author:
Anjali Subbaswamy, MD
What to Do - Gather Appropriate Data
Syncope/Long QT. Syncope is a loss of consciousness related to decreased
cerebralperfusiontotheareasofthebrainnecessaryforconsciousness,which
include... Suggested Readings
... READ EXCERPTS »
... Nancy Drucker, MD Syncope - BASICS Syncope - description Loss of consciousness, typically lasting no longer than 1–2 minutes, due to a transient drop in cerebral perfusion pressure Syncope - general prevention ... Syncope - DIAGNOSIS ... Syncope - TREATMENT ... Syncope - FOLLOW UP ... Syncope - bibliography ... Syncope - CODES ... Syncope - FAQ
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Epilepsy does not have to stand in the way of a pregnancy. The best way to ensure a safe and healthy baby is to discuss your treatment options with...
In the past, treating kids with epilepsy might have meant using a combination of drugs that had unwanted side effects. Now it's possible for kids...
Deciding on treatment for the seizure disorder epilepsy involves balancing several factors, including the kinds of seizures being treated and...
Children whose epilepsy is not controlled through medications may want to consider alternatives. Learn about one option that is growing in popularity.