fox wrote:
EEG....jerking of the upper extremities prior to fall seems to be the catch word
yes , but jerking may also occur in vasovagal syncope >>>>thay is why differentiation between syncope and epilepsy is essential.
i excluded seizure because the patient give a prodroma typical of vasovagal syncope.
Also it is not seizure because i think coma of epilepsy should be longer ( about half an hour )...
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| Aashi
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Answer:
(D) Tilt-table testing
Explanation:
Syncope of neurovasogenic (vasovagal) etiology is often mistaken for a seizure, especially in patients who have abnormal muscular movements. However, this patient recovered rapidly with no postictal symptoms, such as persistent confusion and an altered mental status. If the defect in cerebral perfusion is severe from a vasovagal episode, there can be accompanying clonic movements and limb hypertonicity.
Tilt-table testing is useful to support diagnosis of neurocardiogenic syncope, especially in patients with recurrent syncope. It is performed by keeping the patient in an upright posture on a tilt table with footboard support. The angle of the tilt table varies from 60 to 80 degrees, and the duration of an upright posture is for 25 to 45 minutes. If the patient has severe hypotension with paradoxical bradycardia, the diagnosis of neurocardiogenic syncope is likely.
Seizure might look like a possible cause in this patient, considering the possible presence of metastasis to the brain. The CT scan in this patient was negative for metastasis. Tilt-table testing provides useful information, although in 30% of cases, the cause of syncope remains unknown.
EEG can help in confirmatory evidence of epilepsy. The sensitivity of EEG is limited; it is normal in up to one fourth of patients with epilepsy.
There isn't enough evidence to prove that this patient had a seizure to indicate that he should be started on antiseizure medications as the initial step in management. A 24-hour Holter monitor may be helpful in evaluating for possible arrhythmias; however, this patient has no evidence of cardiovascular disease. An MRI would be important in identifying an etiology in a patient with a seizure. The patient could have small lesions not fully visible on the CT scan.
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"Obstacles are those frightful things you see when you take your EYES off your goal."
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