Syncope or fainting episode requires immediate medical attention as it is associated with neurological responses in the body. Syncope episdoes are related to the malfunction or altered function of important physiological activities in the body. Syncope is categorized into cardiovascular and non-cardiovascular types depending on the underlying case of ischemia. Presyncope is a precursor to the onset of syncope as the patient begins to experience lightheadedness or dizziness.
Clinical manifestations of presyncope
Presyncope or dizziness is often related to vertigo during clinical evaluation of the patient. Vomiting and nausea are two classical signs indicating the onset of a presyncope episode. In most cases people travelling to higher altitudes and regions of low oxygen concentration experience this. In some cases these symptoms occur because of extreme physical activity, improper nutrition, underlying cardiac condition and also diabetes. Syncope or presyncope is associated with apnea as there is decreased oxygen supply to the brain. Patients experience abdominal discomfort, blurred vision and also headaches during the presyncope episode. Presyncope episodes can be very dangerous during driving as it may lead to accidents. Disorientation is also an important symptom in identifying the onset of presyncope which subsequently leads to syncope.
Diagnosis of presyncope
The diagnosis of presyncope-related episodes is dependent on the identification of underlying cardiac and neurological conditions. Thorough analysis of the heart functionality, respiratory parameters and neurological functions are conducted. In many cases presyncope and episodes of syncope are closely associated with ischemic heart disease. Carotid artery palpation and examination of left ventricular flow are done. Presyncope episode is a warning sign of an impending physiological transition or complication. Cerebral blood flow obstruction caused due to pulmonary embolism is also a major factor for the onset of syncope.
Treatment of presyncope
Presyncope diagnosis is associated with existing medical conditions. Studies indicate that presyncope is also caused due to psychological disorders such as anxiety and panic. The patient is initially examined for underlying cardiac or neurological disorders before treating presyncope. The most common methods of treatment are through diet counseling such as fluid and salt intake. Patients prone to presyncope episodes are advised to avoid sauna, steam showers and also highly populated areas. Medications such as beta blockers, ephedrine, pseudoephedrine, theophylline, sertraline and fluoxetine are suggested for presyncope and cardio-neurogenic syncope conditions.
Seizures or convulsions are associated with the electrical activity of the brain. They have an impact on major systems of the body and can be fatal if not treated. Seizures are classified predominantly based upon their site of occurrence and the affected organ or system.
Types of Convulsions
General or clonic seizures: In most cases, generalized seizures are also called as tonic-clonic seizures as they involve the entire body. In common parlance, it also referred as epileptic attacks. Patients experience changes in sensations such touch, taste, smell and vision. Hallucinations or auras are also experienced as they begin to influence the emotional balance of a person.
Focal or Partial seizures: These types of seizures are cause because of disturbed electrical activity in the brain which is localized to one part of the brain. It acts on the temporal region of the brain leading loss of memory and balance in extreme conditions.
Petit mal Seizures: These are temporary and their effects are usually limited to 20 seconds. They generate temporary muscle spasms which happen because of electrical imbalances in the brain.
Epilepsy: This type of seizure is closely related to general seizures. The factors associated with the onset of epilepsy may include preexisting conditions such as ischemic heart disease, Alzheimer disease, meningitis and encephalitis.
Fever induced convulsions: These types of seizures predominantly occur in children, infants and toddlers. The initial phase of these convulsions is very intense as they cause much discomfort to the child. They usually subside within a few hours. Most of the fever induced convulsions are caused by viruses and ear infections.
Most convulsions or seizures are characterized by classical muscle spasm symptoms which includes rigorous shaking and frothing with prolonged effects like unconsciousness (blackout). Since the predominant reason associated with convulsions are related to the electrophysiology of the brain, neurological symptoms such as confusion, hallucination, dementia, drooling, lack of bladder control and sudden loss of balance may also be noticed.
Convulsions also have effects on the emotions of a person as many people complain of unprecedented symptoms such as sudden aggression, depression, mood swings, panic, extreme laughter and joy for a temporary period of time. Warning signs often appear before any form of seizure such as dizziness, sensitivity to light, vertigo and nausea.
Seizures can also occur as a result of withdrawal from use of drugs such as barbiturates, valium or benzodiazepines. Drug abuse and alcohol abuse along with preexisting health complications such as end-stage renal disease, renal failure and congenital heart disease can indicate high percentage of seizure onset. Seizures also occur in conditions such as Steven Johnson syndrome, a disease occurring in children. In addition to these clinical manifestations, seizures can occur because of severe brain injury, shock or even during athletic events as result of extreme adrenaline levels in the blood.
Diagnosis and Treatment
Epileptics are diagnosed with a meticulous examination of their history. Various biochemical tests such as sodium levels, SGOT, SGPT and blood glucose levels are analyzed. Electro encephalogram is done to understand the electrophysiology of the brain. In some cases, neurologists recommend MRI and CT scans to understand the presence of any abnormalities or to identify any kind of trauma caused in the brain or the spinal cord.
In most cases seizures are treated with antidepressants as the predominant cause of any form of seizure is depression. Anti epileptic drugs such as sodium channel blockers and GABA transaminase inhibitors are recommended.
SPECT or Single Photon Emission Computed Tomography is a diagnostic tool that that uses gamma camera to collect gamma rays that are emitted from the patient. Radioactive isotope is administered to the patient either as injection or inhalation or ingested liquid. SPECT imaging helps acquire multiple images from multiple angles. The gamma camera is rotated around the patient. Dual-headed cameras can help in accelerating the test. Often triple-headed cameras are also used. SPECT is particularly useful in imaging of tumors, bones, thyroid and infections. Cardial imaging and brain imaging provide critical information about localized functions. MPI (Myocardial perfusion imaging) is an important cardiac stress test. SPECT images allow diagnosis of ischemic heart disease. This test is comparable to stress echocardiography. SPECT imaging of the brain aids in distinguishing Alzheimer's disease from other vascular dementia. Nearly 30 or more images are taken of the specific body area that is being viewed. SPECT scanning is time consuming.
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Bibliography / Reference
Collection of Pages - Last revised Date: November 15, 2019