scholarly journals An unusual case of loss of consciousness: when an epileptic brain let the heart slow down

2012 ◽  
Vol 6 (1) ◽  
pp. 15-19 ◽  
Author(s):  
Giovanni Assenza ◽  
Federica Assenza ◽  
Giovanni Pellegrino ◽  
Mario Tombini
Keyword(s):  
Differential Diagnosis ◽  
Unusual Case ◽  
Muscular Activity ◽  
Neurological Symptoms ◽  
Loss Of Consciousness ◽  
Transient Loss Of Consciousness ◽  
Transient Loss ◽  
Polygraphic Recording ◽  
Electroencephalographic Activity ◽  
Panayiotopoulos Syndrome

The differential diagnosis of an episode of transient loss of consciousness can be sometimes very tricking, in particular when symptoms peculiar of syncope are mixed with focal neurological symptoms. We report the case of a 54-year-old woman who suddenly claimed, during a polygraphic recording (electroencephalography/electrocardiogram), a feeling of fear and tachycardia followed by loss of consciousness and then a tonic posturing of the left limbs. Polygraphic recording showed a critical electroencephalographic pattern starting from left temporo-zygomatic channels followed after few seconds by a sudden slowing of cortical background activity associated with an episode of asystole, as witnessed simultaneously by electrocardiogram. Muscular activity covered electroencephalographic activity of following minutes. This case provides an opportunity to highlight the existence of rare conditions such as ictal arrhythmias which should be considered in the differential diagnosis of episodes of transient loss of consciousness in particular when dysautonomic and neurological symptoms are intermingled. Autonomic symptoms (vomiting, tachycardia, cyanosis, bradycardia and asystole) may be also more frequent in idiopathic (more rarely symptomatic) epilepsies of childhood (Panayiotopoulos syndrome).

#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.

Is it syncope? Differential diagnosis of transient loss of consciousness in the emergency department

2015 ◽  
Vol 192 ◽  
pp. 103
Author(s):  
L. Furlan ◽  
D. Lorenzonetto ◽  
M. Solbiati ◽  
M. Bonzi ◽  
G. Cassano ◽  
...  
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Loss Of Consciousness ◽  
Transient Loss Of Consciousness ◽  
Transient Loss

Delayed transient loss of consciousness in acute carbon monoxide intoxication

1999 ◽  
Vol 18 (10) ◽  
pp. 642-643 ◽  
Author(s):  
M L Benaissa ◽  
F Lapostolle ◽  
S W Borron ◽  
F J Baud
Keyword(s):  
Carbon Monoxide ◽  
Prognostic Factor ◽  
Unusual Case ◽  
Carbon Monoxide Poisoning ◽  
Loss Of Consciousness ◽  
Altered Consciousness ◽  
Poor Prognostic Factor ◽  
Transient Loss Of Consciousness ◽  
Carbon Monoxide Intoxication ◽  
Transient Loss

In acute carbon monoxide intoxication the presence of altered consciousness, ranging from transient loss of consciousness to coma, represents a poor prognostic factor and modifies the approach to therapy. Transient loss of consciousness is, as a rule, contemporaneous to the exposure, generally occurring at the scene of the intoxication. We report an unusual case of delayed transient loss of consciousness, occurring in the absence of any other evident aetiology, in one member of an orchestra composed of 110 members after a mass carbon monoxide poisoning.

Value of witness observations in the differential diagnosis of transient loss of consciousness

Neurology ◽  
2019 ◽  
pp. 10.1212/WNL.0000000000007017 ◽  
Author(s):  
Min Chen ◽  
Jenny Jamnadas-Khoda ◽  
Mark Broadhurst ◽  
Melanie Wall ◽  
Richard Grünewald ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Loss Of Consciousness ◽  
Transient Loss Of Consciousness ◽  
Transient Loss

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

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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