Epilepsy Lightheadedness and Syncope Dr Mohamad Shehadeh Agha

To define the story inquire about Pre-attack Attack Post-attack

Seizures Pre-attack: no warning or aura Attack: tonic phase the respiration ceases, cyanosis Clonic

Syncope Pre-attack: nausea , dizziness, sweating, … Attack: gradual, fall, pale, occasionally shivering, if

Psychogenic attack Occurs in front of people No injury Prolonged attack Red in face

Epilepsy It is the consequence of focal or generalized epileptogenic. discharges in the brain

Classification of Epilepsy Generalized seizures 1. Absence attacks (petit mal) 2. Myoclonus 3. Clonic

Partial seizures A. Simple Partial (consciousness preserved) 1. Motor symptoms 2. Somatosensory symptoms 3.

Partial seizures B. Complex Partial (consciousness impaired) 1. Motor symptoms 2. Somtosensory symptoms 3.

Partial seizures C. Partial seizures with secondary generalization

Syncope It is caused by sudden drop in. blood flow to the brain

This may lead to abrupt loss of consciousness either without any warning or with

Without any warning Syncope due to aortic stenosis. or complete heart block

Preceding symptoms Feeling of faintness Lightheadedness Dizziness Bilateral dimming or loss of vision General

Causes of syncope Vasovagal syncope Postural hypotension Cardiac arrhythmia Valsalva maneuver Structural cardiac disorders

Psychogenic attacks Panic attacks Functional overbreathing Pseudoseizures Agoraphobia

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Epilepsy, Lightheadedness and Syncope Dr Mohamad Shehadeh Agha MD MRCP(UK) ﻣﺤﻤﺪ ﺷﺤﺎﺩﻩ آﻐﺎ. ﺩ

To define the story inquire about Pre-attack Attack Post-attack

WITNESS

Seizures Pre-attack: no warning or aura Attack: tonic phase the respiration ceases, cyanosis Clonic phase jerking all four limbs tongue biting+/- incontinence Post attack: deep sleep diffuse bodily aching or stiffness

Syncope Pre-attack: nausea , dizziness, sweating, … Attack: gradual, fall, pale, occasionally shivering, if prolonged may progress to GTC Post-attack: rapid return to consciousness when flat on floor

Psychogenic attack Occurs in front of people No injury Prolonged attack Red in face Attempt to open the eyes may lead to voluntary contractions of the orbicularis oculi and upward deviation of the eyes. Allowing the limp hand to fall on the face may be resisted.

Epilepsy It is the consequence of focal or generalized epileptogenic. discharges in the brain

Classification of Epilepsy Generalized seizures 1. Absence attacks (petit mal) 2. Myoclonus 3. Clonic 4. Tonic 5. Tonic-Clonic (grand mal) 6. Atonic

Partial seizures A. Simple Partial (consciousness preserved) 1. Motor symptoms 2. Somatosensory symptoms 3. Autonomic 4. Psychic 5. Mixed forms

Partial seizures B. Complex Partial (consciousness impaired) 1. Motor symptoms 2. Somtosensory symptoms 3. Autonomic 4. Psychic 5. Mixed forms 6. Impaired consciousness alone

Partial seizures C. Partial seizures with secondary generalization

Syncope It is caused by sudden drop in. blood flow to the brain

This may lead to abrupt loss of consciousness either without any warning or with preceding. symptoms

Without any warning Syncope due to aortic stenosis. or complete heart block

Preceding symptoms Feeling of faintness Lightheadedness Dizziness Bilateral dimming or loss of vision General weakness Nausea Hot or cold feeling Sweating Sounds seem distant

Causes of syncope Vasovagal syncope Postural hypotension Cardiac arrhythmia Valsalva maneuver Structural cardiac disorders Acute circulatory failure Micturation syncope Cough syncope

Psychogenic attacks Panic attacks Functional overbreathing Pseudoseizures Agoraphobia