scholarly journals Recognizing Syncope: Pitfalls and Surprises

1996 ◽  
Vol 89 (7) ◽  
pp. 372-375 ◽  
Author(s):  
T Lempert
Keyword(s):  
Creatine Kinase ◽  
Differential Diagnosis ◽  
Head Injury ◽  
Muscle Activity ◽  
Epileptic Seizures ◽  
Accurate Information ◽  
Loss Of Consciousness ◽  
Mere Presence ◽  
Key Features ◽  
Premonitory Symptoms

Loss of consciousness and falling are the key features of syncope. Common accompaniments include tonic and myoclonic muscle activity, eye deviations, automatisms, vocalizations and hallucinations which may render the distinction from epileptic seizures difficult. Differential diagnosis is based on the specific features and not the mere presence of these phenomena. Recognition of syncope depends also on accurate information about precipitants, premonitory symptoms and postictal events: the absence of postictal confusion has been identified as the single most powerful factor discriminating syncope from epileptic seizures whereas incontinence and head injury are common in both conditions. Investigations such as electroencephalogram, tilt testing and postictal prolactin or creatine kinase levels may be helpful but are never diagnostic in isolation. Exceptionally, hypoxic and epileptic mechanisms interact within a single attack.

Postictal serum creatine kinase for the differential diagnosis of epileptic seizures and psychogenic non-epileptic seizures: a systematic review

2014 ◽  
Vol 262 (2) ◽  
pp. 251-257 ◽  
Author(s):  
Francesco Brigo ◽  
Stanley C. Igwe ◽  
Roberto Erro ◽  
Luigi Giuseppe Bongiovanni ◽  
Antonio Marangi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Creatine Kinase ◽  
Differential Diagnosis ◽  
Epileptic Seizures ◽  
Serum Creatine Kinase

Synkope, epileptischer oder psychogener Anfall? Der Weg zur richtigen Diagnose

2019 ◽  
Vol 144 (12) ◽  
pp. 835-841
Author(s):  
Tobias Baumgartner ◽  
Rainer Surges
Keyword(s):  
Emergency Room ◽  
Daily Life ◽  
Epileptic Seizures ◽  
Loss Of Consciousness ◽  
Transient Loss Of Consciousness ◽  
Daily Life Activities ◽  
Transient Loss ◽  
Impact On Treatment ◽  
Key Features ◽  
The Impact

AbstractTransient loss of consciousness (TLOC) is a frequent cause of referral to an emergency room. In view of the impact on treatment and the patients’ daily life activities (e. g. profession, driving license), an accurate and timely diagnosis is of uttermost importance. This article provides key features and suggests a practical step-by-step approach of how to differentiate syncope, epileptic and psychogenic non-epileptic seizures as the commonest causes of nontraumatic TLOC.

#3079 Investigating the feasibility of automating the differential diagnosis of transient loss of consciousness

2021 ◽  
Vol 92 (8) ◽  
pp. A7.1-A7
Author(s):  
Nathan Pevy ◽  
Heidi Christensen ◽  
Traci Walker ◽  
Markus Reuber
Keyword(s):  
Differential Diagnosis ◽  
Random Forest ◽  
Epileptic Seizures ◽  
The Other ◽  
Future Research ◽  
Loss Of Consciousness ◽  
Transient Loss Of Consciousness ◽  
Audio Recordings ◽  
Transient Loss ◽  
Nonepileptic Seizures

BackgroundThere are three common causes of Transient Loss of Consciousness (TLOC), syncope, epileptic and psychogenic nonepileptic seizures (PNES). Many individuals who have experienced TLOC initially receive an incorrect diagnosis and inappropriate treatment. Whereas syncope can be distinguished from the other two causes relatively easily with a small number of yes/no questions, the differentiation of the other two causes of TLOC is more challenging. Previous qualitative research based on the methodology of Conversation Analysis has demonstrated that epileptic and nonepileptic seizures are described differently when patients talk to clinicians about their TLOC experiences. One particularly prominent difference is that epileptic seizure descriptions are characterised by more formulation effort than accounts of nonepileptic seizures.AimThis research investigates whether features likely to reflect the level of formulation effort can be automatically elicited from audio recordings and transcripts of speech and used to differentiate between epileptic and nonepileptic seizures.MethodVerbatim transcripts of conversations between patients and neurologists were manually produced from video and audio recordings of interactions with 45 patients (21 epilepsy and24 PNES). The subsection of each transcript containing the patients account of their first seizure was manually extracted for the analysis. Seven automatically detectable features were designed as markers of formulation effort. These features were used to train a Random Forest machine learning classifier.ResultsThere were significantly more hesitations and repetitions in descriptions of first epileptic than nonepileptic seizures. Using a nested leave-one-out cross validation approach, 71% of seizures were correctly classified by the Random Forest classifier.ConclusionsThis pilot study provides proof of principle that linguistic features that have been automatically extracted from audio recordings and transcripts could be used to distinguish between epileptic seizures and PNES and thereby contribute to the differential diagnosis of TLOC. Future research should explore whether additional observations can be incorporated into a diagnostic stratification tool. Moreover, future research should explore the performance of these features when they have been extracted from transcripts produced by automatic speech recognition and when they are combined with additional information provided by patients and witnesses about seizure manifestations and medical history.

Can conversation analytic findings help with differential diagnosis in routine seizure clinic interactions?

2016 ◽  
Vol 12 (1) ◽  
pp. 13-24 ◽  
Author(s):  
Katie Ekberg ◽  
Markus Reuber
Keyword(s):  
Differential Diagnosis ◽  
Correct Diagnosis ◽  
Diagnostic Errors ◽  
Epileptic Seizures ◽  
Routine Clinical Setting ◽  
Choice Of Treatment ◽  
Transient Loss ◽  
Factual Content ◽  
Patient’S History ◽  
Linguistic Methods

There are many areas in medicine in which the diagnosis poses significant difficulties and depends essentially on the clinician’s ability to take and interpret the patient’s history. The differential diagnosis of transient loss of consciousness (TLOC) is one such example, in particular the distinction between epilepsy and ‘psychogenic’ non-epileptic seizures (NES) is often difficult. A correct diagnosis is crucial because it determines the choice of treatment. Diagnosis is typically reliant on patients’ (and witnesses’) descriptions; however, conventional methods of history-taking focusing on the factual content of these descriptions are associated with relatively high rates of diagnostic errors. The use of linguistic methods (particularly conversation analysis) in research settings has demonstrated that these approaches can provide hints likely to be useful in the differentiation of epileptic and non-epileptic seizures. This paper explores to what extent (and under which conditions) the findings of these previous studies could be transposed from a research into a routine clinical setting.

scholarly journals Bladder perivascular epithelioid cell neoplasm: The importance of immunohistochemistry in the diagnosis of an unusual neoplasm

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110008
Author(s):  
Solange De Noon ◽  
Benjamin Ayres ◽  
Uday Patel ◽  
Rami Issa ◽  
Colan Maxwell Ho-Yen
Keyword(s):  
Differential Diagnosis ◽  
Epithelioid Cell ◽  
Review Of The Literature ◽  
Histological Features ◽  
Perivascular Epithelioid Cell Neoplasms ◽  
Perivascular Epithelioid Cell ◽  
Organ Systems ◽  
Cell Neoplasm ◽  
Key Features ◽  
Mesenchymal Tumours

Perivascular epithelioid cell neoplasms represent a group of uncommon mesenchymal tumours with as yet undiscovered benign counterpart. Although perivascular epithelioid cell neoplasms have been described arising in most organ systems as well as in soft tissue and bone, only a small number of perivascular epithelioid cell neoplasms have been reported in the bladder. To date, there is no agreed system for predicting the behaviour of these tumours. We describe a case of a perivascular epithelioid cell neoplasm of the bladder arising in a 57-year-old male and initially diagnosed on biopsy and present a review of the literature focussing on the pathological differential diagnosis and the importance of key histological features in conjunction with a broad immunohistochemical panel. This case report highlights the key features of bladder perivascular epithelioid cell neoplasms that distinguishes these rare neoplasms from other bladder lesions.

Epilepsy and Related Disorders

2018 ◽  
Author(s):  
Barbara Dworetzky ◽  
Jong Woo Lee
Keyword(s):  
Differential Diagnosis ◽  
Generic Drugs ◽  
Sudden Change ◽  
Epileptic Seizures ◽  
Quality Measures ◽  
The Elderly ◽  
Childhood And Adolescence ◽  
Nonepileptic Seizures ◽  
Infancy And Early Childhood ◽  
The Brain

Epilepsy is a chronic disorder of the brain characterized by recurrent unprovoked seizures. A seizure is a sudden change in behavior that is accompanied by electrical discharges in the brain. Many patients presenting with a first-ever seizure are surprised to find that it is a very common event. A reversible or avoidable seizure precipitant, such as alcohol, argues against underlying epilepsy and therefore against treatment with medication. This chapter discusses the epidemiology, etiology, and classification of epilepsy and provides detailed descriptions of neonatal syndromes, syndromes of infancy and early childhood, and syndromes of late childhood and adolescence. The pathophysiology, diagnosis, and differential diagnosis are described, as are syncope, migraine, and psychogenic nonepileptic seizures. Two case histories are provided, as are sections on treatment (polytherapy, brand-name versus generic drugs, surgery, stimulation therapy, dietary treatments), complications of epilepsy and related disorders, prognosis, and quality measures. Special topics discussed are women?s issues and the elderly. Figures illustrate a left midtemporal epileptic discharge, wave activity during drowsiness, cortical dysplasias, convulsive syncope, rhythmic theta activity, right hippocamal sclerosis, and right temporal hypometabolism. Tables describe international classifications of epileptic seizures and of epilepsies, epilepsy syndromes and related seizure disorders, differential diagnosis of seizure, differentiating epileptic versus nonepileptic seizures, antiepileptic drugs, status epilepticus protocol for treatment, when to consider referral to a specialist, and quality measures in epilepsy.  This review contains 7 figures, 10 tables, and 33 references. Key Words: Seizures, focal (partial)seizure, generalized seizures, Myoclonic seizures, Atonic seizures, Concurrent electromyographyTonic-clonic (grand mal) seizures

THE DIAGNOSTIC VALUE OF SERUM CREATINE KINASE IN NEUROMUSCULAR AND MUSCULAR DISEASE

PEDIATRICS ◽  
1965 ◽  
Vol 35 (2) ◽  
pp. 322-330
Author(s):  
Franco Vassella ◽  
Roland Richterich ◽  
Ettore Rossi
Keyword(s):  
Creatine Kinase ◽  
Muscular Dystrophy ◽  
Epileptic Seizures ◽  
Lactic Dehydrogenase ◽  
Diagnostic Value ◽  
Creatine Kinase Activity ◽  
Serum Creatine Kinase ◽  
Progressive Muscular Dystrophy ◽  
Muscular Disease ◽  
Muscle Specificity

Serum creatine kinase activity in 200 patients was studied in order to check whether this determination might be of help in differential diagnosis between primary and secondary (neurogenic) myopathies. Elevated CK values are found physiologically in children, pregnant women, and after exercise. In pathological states increased serum enzyme concentrations (probably the expression of a defect in cellular permeability) are constantly present in the Duchenne type of progressive muscular dystrophy. More variable values are encountered in other types of muscular dystrophy and in metabolic disorders like Refsum's syndrome, coproporphyria, and hypothyroidism. In states of necrosis or injury to muscle cells like in polymyositis, dermatomyositis, after burns or trauma, serum CK concentrations vary according partly to the amount of muscle mass involved. Enzyme concentrations can be markedly increased after tetany or epileptic seizures. Normal values or occasionally slightly increased values are found in neurogenic myopathies. High CK values in patients with muscular atrophies should permit the clinician to exclude the differential diagnostic group of neurogenic myopathies. As a diagnostic tool CK proved to be more reliable than transaminases or lactic dehydrogenase because of its higher muscle specificity and a slightly greater sensitivity.

The management of acute shortness of breath in young adults

2013 ◽  
Vol 99 (3) ◽  
pp. 92-96
Author(s):  
V Y Ahuja ◽  
D Freshwater
Keyword(s):  
Young Adults ◽  
Differential Diagnosis ◽  
Risk Stratification ◽  
Acute Care ◽  
Common Type ◽  
Shortness Of Breath ◽  
The Third ◽  
Significant Pathology ◽  
Key Features ◽  
Simultaneous Assessment

AbstractShortness of breath (SOB), or dyspnoea, is a common presenting symptom in acute care, responsible for 8% of all 999 calls to the ambulance service and ranking as the third most common type of emergency call (1). It may be associated with significant pathology, so prompt identification and appropriate management are therefore imperative. Although a formal diagnosis guides risk stratification, prognostication and treatment, it must not delay resuscitation. Rather, the management of an acutely short of breath (ASOB) patient must follow an algorithm incorporating simultaneous assessment and resuscitation. This article discusses both of these aspects in some detail, as well as key features in the history and the differential diagnosis, before concluding with some consideration of how the different operational environments in which such patients can present may affect their management.

Using illness narratives in clinical diagnosis

2018 ◽  
pp. 203-219
Author(s):  
Elisabeth Gülich
Keyword(s):  
Differential Diagnosis ◽  
Anxiety Disorders ◽  
Clinical Diagnosis ◽  
Basic Assumption ◽  
Epileptic Seizures ◽  
Illness Narratives ◽  
Panic Attacks ◽  
Patient Interactions ◽  
Narrative Patterns ◽  
Narrative Techniques

This chapter argues that illness narratives are a suitable instrument for differential diagnosis in practice. The study discussed is based on a corpus of doctor–patient interactions, i.e., encounters with patients suffering from epileptic or non-epileptic seizures and/or anxiety disorders, and for most of whom differential diagnosis is very difficult. The basic assumption put forward here is that the types of narrative can give clues to identify the types of seizures or attacks. The focus is on the ‘methods’ patients use in verbalizing the ‘auras’ preceding the seizures and the course of the seizures or attacks themselves. In particular, it pays attention to the procedures of resolving difficulties of verbalization, which occur during the production of the narrative. It demonstrates that preferences in the choice of narrative techniques allow a distinction between patients with epileptic seizures and patients with other types of fits or with panic attacks. Finally it suggests that knowledge of recurrent narrative patterns can help to recognize the syndrome presented, on condition that the doctor encourages narrative reconstructions and listens carefully.

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