LOSS OF CONSCIOUSNESS

Key History:
 Presence or absence of preceding symptoms (nausea, diaphoresis, palpitation, pallor,
lightheadedness),
 context (exertional, postural, traumatic; stressful, painful, or claustrophobic
experience; dehydration);
 associated tongue biting, incontinence, tonic-clonic movements, prolonged
confusion; dyspnea or pulmonary embolism risk factors;
 history of heart disease, arrhythmia, hypertension, or diabetes;
 alcohol and drug use.

Key Physical Exam

 Vital signs, including orthostatics;
 complete neurologic exam;
 carotid and cardiac exam;
 lung exam;
 exam of the lower extremities

Presentation
26 yo M presents after falling and losing consciousness at work. He had rhythmic
movements of the limbs, bit his tongue, and lost control of his bladder. He was
subsequently confused (as witnessed by his colleagues).

Differential
1. Seizure, grand mal (now called complex tonic-clonic seizure)
2. Convulsive syncope
3. Substance abuse/overdose
4. Malingering
5. Hypoglycemia

Workup
1. CBC, electrolytes, glucose
2. Urine toxicology
3. EEG
4. MRI—brain
5. CT—head
1
 LOSS OF CONSCIOUSNESS

6. LP—CSF analysis
7. ECG