Aashi
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A 30-year-old man is brought to the emergency department by his girlfriend after he loses consciousness. He has had similar episodes in the past, but this is the first one his girlfriend has seen. During these episodes, he has been diaphoretic and pale. His girlfriend says that he complained of graying of his vision, lightheadedness, and a sensation of feeling warm. He also had repetitive jerks of his body. This lasted for 45 seconds, and then he became oriented to his surroundings in less than a minute. The patient is thin and underweight and has dry skin, teeth erosions, and brittle nails. He complains of some muscle pain. His prolactin level is normal. What is the most likely diagnosis?
(A) Generalized seizure
(B) Transient ischemic attack (TIA)
(C) Pseudoseizure due to eating disorder
(D) Syncope
(E) Hypothyroidism
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| drashishmahajan
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C
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| prathapdoctor
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i think its syncope.
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| fox
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I too think its syncope, but cant understand the significance of his skin & nail changes. Probably its a case of type 1 Diabetes with neuropathy. Not sure though.
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| Aashi
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 tricky tricky tricky!
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| dr.wad
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| webjeee
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why not
(A) Generalized seizure
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| Aashi
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Answer:
(D) Syncope
Explanation:
This is a young man with what may be an eating disorder and episodes of syncope. This is not likely to be a seizure because seizures can be characterized by an aura, automatisms, tonic-clonic movements, tongue biting, and incontinence. Patients with seizures often have a period after the seizure marked by amnesia, aphasia, Todd's paralysis, muscle pain, and disorientation. This postictal state usually lasts from several minutes to several hours. This patient became normal in a matter of seconds after the event. Prolactin levels measured within 20 minutes of the event may be elevated after a genuine seizure. The pattern of activity can also be helpful to distinguish seizures from pseudoseizures. Pseudoseizures are characterized by pelvic thrusting, nonconvulsive limb movements, voluntary eye closure, and a normal prolactin level. There is often a history of prior sexual abuse. It is unlikely that he had a transient ischemic attack (TIA) because he is very young, and there is no reason to suspect a markedly increased risk of vascular disease. He also has no focal neurological abnormalities. Hypothyroidism can be excluded with laboratory tests. It is also very unlikely that hypothyroidism would cause a seizure. Syncope is characterized by pallor, nausea, diaphoresis, and specific, provoking events.
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