Orthostatic Hypotension As Cause of Syncope in Patients Older Than 65 Years Admitted to Emergency Departments for Transient Loss of Consciousness

Syncope can closely resemble other disorders with which it shares an apparent short-lived transient loss of consciousness. Together, these disorders are labelled as ‘transient loss of consciousness (T-LOC)’. Syncope is the form of T-LOC caused by cerebral hypoperfusion; the other main T-LOC forms are several types of epileptic seizures and the psychogenic conditions that resemble either syncope or epileptic seizures. The main forms of syncope are reflex syncope, syncope due to orthostatic hypotension, and cardiac syncope, also comprising cardiopulmonary causes and disorders of the great vessels. All forms of syncope share cerebral hypoperfusion and arterial hypotension as a final common pathway. They differ in the mechanism of hypotension: cardiac syncope is largely due to a low cardiac output, but in orthostatic hypotension and reflex syncope both low peripheral resistance and low cardiac output contribute to syncope. The clinical expression of the main forms is tightly linked to their pathophysiology, which is therefore important for differential diagnosis.

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Transient loss of consciousness

10.1093/med/9780199568741.003.0039 ◽

2018 ◽

Author(s):

Jonathan Timperley ◽

Sandeep Hothi

Keyword(s):

Cardiovascular Disease ◽

Orthostatic Hypotension ◽

Short Duration ◽

Complete Recovery ◽

Complete Loss ◽

Cerebral Hypoperfusion ◽

Clinical Approach ◽

Loss Of Consciousness ◽

Transient Loss Of Consciousness ◽

Transient Loss

Transient loss of consciousness (TLoC) is characterized by a rapid, transient, and complete loss of consciousness of short duration with spontaneous, complete recovery. Syncope is a specific type of TLoC caused by transient, global, cerebral hypoperfusion. TLoC may be traumatic or non-traumatic. Causes of non-traumatic TLoC include syncope, epilepsy, psychogenic causes, and other, rarer causes. Syncope may be reflex (neurally mediated), due to orthostatic hypotension or to cardiovascular disease. This chapter describes the clinical approach to the patient with transient loss of consciousness.

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Definition, epidemiology, classification, and pathophysiology

ESC CardioMed ◽

10.1093/med/9780198784906.003.0468 ◽

2018 ◽

pp. 2017-2021

Author(s):

J. Gert van Dijk ◽

Roland D. Thijs

Keyword(s):

Cardiac Output ◽

Orthostatic Hypotension ◽

Epileptic Seizures ◽

Cerebral Hypoperfusion ◽

Loss Of Consciousness ◽

Low Cardiac Output ◽

Transient Loss Of Consciousness ◽

Reflex Syncope ◽

Cardiac Syncope ◽

Transient Loss

Syncope can closely resemble other disorders with which it shares an apparent short-lived transient loss of consciousness. Together, these disorders are labelled as ‘transient loss of consciousness (T-LOC)’. Syncope is the form of T-LOC caused by cerebral hypoperfusion; the other main T-LOC forms are several types of epileptic seizures and the psychogenic conditions that resemble either syncope or epileptic seizures. The main forms of syncope are reflex syncope, syncope due to orthostatic hypotension, and cardiac syncope, also comprising cardiopulmonary causes and disorders of the great vessels. All forms of syncope share cerebral hypoperfusion and arterial hypotension as a final common pathway. They differ in the mechanism of hypotension: cardiac syncope is largely due to a low cardiac output, but both low peripheral resistance and low cardiac output contribute to syncope due to orthostatic hypotension and reflex syncope. The clinical expression of the main forms is tightly linked to their pathophysiology, which is therefore important for differential diagnosis.

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Vertigo and Transient Loss of Consciousness

Journal of Neuroinfectious Diseases ◽

10.4172/2314-7326.1000271 ◽

2017 ◽

Vol 08 (04) ◽

Author(s):

Xiaodong Chen ◽

Yuangwei Wang

Keyword(s):

Loss Of Consciousness ◽

Transient Loss Of Consciousness ◽

Transient Loss

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Management of transient loss of consciousness of suspected syncopal cause, after the initial evaluation in the Emergency Department

Emergency Care Journal ◽

10.4081/ecj.2016.6046 ◽

2016 ◽

Vol 1 (1) ◽

Author(s):

Ivo Casagranda ◽

Michele Brignole ◽

Simone Cencetti ◽

Gianfranco Cervellin ◽

Giorgio Costantino ◽

...

Keyword(s):

Emergency Department ◽

Initial Evaluation ◽

Loss Of Consciousness ◽

Transient Loss Of Consciousness ◽

Risk Levels ◽

Risk Patients ◽

Life Threatening ◽

Transient Loss ◽

Multidisciplinary Group ◽

Diagnostic Investigations

The recommendations enclosed in the present document have been developed by a group of experts appointed by the <em>Gruppo Multidisciplinare per lo Studio della Sincope</em> (Multidisciplinary Group for the Study of Syncope; GIMSI) and Academy of Emergency Medicine and Care (AcEMC). The aim is to define the diagnostic pathway and the management of patients referred to the Emergency Department (ED) for transient loss of consciousness of suspected syncopal cause, which is still unexplained after the initial evaluation. The risk stratification enables the physician to admit, discharge or monitor shortly the patient in the intensive short-stay Syncope Observation Unit (SOU). There are three risk levels of life-threatening events or serious complications (low, moderate, high). Low risk patients can be discharged, while high risk ones should be monitored and treated properly in case of worsening. Moderate risk patients should undergo clinical and instrumental monitoring in SOU, inside the ED. In all these three cases, patients can be subsequently referred to the Syncope Unit for further diagnostic investigations.

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Transient Loss of Consciousness

Decision Algorithms for Emergency Neurology ◽

10.1007/978-3-030-51276-7_1 ◽

2020 ◽

pp. 1-16

Author(s):

Giuseppe Micieli ◽

Umberto Aguglia ◽

Francesca Baschieri ◽

Giovanna Calandra Buonaura ◽

Anna Cavallini ◽

...

Keyword(s):

Loss Of Consciousness ◽

Transient Loss Of Consciousness ◽

Transient Loss

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Utility of Video-EEG for Diagnosing and Understanding Transient Loss of Consciousness

Syncope ◽

10.1007/978-3-030-44507-2_20 ◽

2020 ◽

pp. 241-251

Author(s):

Maryam Ghariq ◽

Roland D. Thijs

Keyword(s):

Loss Of Consciousness ◽

Transient Loss Of Consciousness ◽

Transient Loss ◽

Video Eeg

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EKG-gyöngyszem: tónusos-clonusos epilepsziás roham kimutatása implantábilis loop recorderrel

Orvosi Hetilap ◽

10.1556/650.2019.31460 ◽

2019 ◽

Vol 160 (29) ◽

pp. 1143-1145

Author(s):

János Tomcsányi ◽

Zoltán Nényei ◽

Anna Kelemen ◽

Anita Kamondi

Keyword(s):

Antiepileptic Drug ◽

Loss Of Consciousness ◽

Implantable Loop Recorder ◽

Loop Recorder ◽

Transient Loss Of Consciousness ◽

Transient Loss ◽

Clonic Seizures

Abstract: A 52-year-old woman is presented with repetitive transient loss of consciousness. Implantable loop recorder (ILR) recorded muscle artifacts during the generalized tonic-clonic seizures. Seizure was diagnosed and antiepileptic drug was started. The patient has been asymptomatic for 9 months. Orv Hetil. 2019; 160(29): 1143–1145.

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