arlete
Lucky woman!
Topics: 49
Posts: 3,465
|
A (and it took too long for her to regain consciousness too).
___________________
Now it's on God's hands. I've done my best!
|
| bariluis
Forum Junior
Topics: 11
Posts: 39
|
Neurogenic syncope occurs because of vagal activation. I agree with arlete. Clonic jerks could not be explained here.
E
|
| Eagle_303
Forum Guru
Topics: 77
Posts: 655
|
Syncope A common neurologic sign, syncope (or fainting) refers to transient loss of consciousness associated with impaired cerebral blood supply or cerebral hypoxia. It usually occurs abruptly and lasts for seconds to minutes. An episode of syncope usually starts as a feeling of light-headedness. A patient can usually prevent an episode of syncope by lying down or sitting with his head between his knees. Typically, the patient lies motionless with his skeletal muscles relaxed but sphincter muscles controlled. However, the depth of unconsciousness varies—some patients can hear voices or see blurred outlines; others are unaware of their surroundings. In many ways, syncope simulates death: The patient is strikingly pale with a slow, weak pulse, hypotension, and almost imperceptible breathing. If severe hypotension lasts for 20 seconds or longer, the patient may also develop convulsive, tonic-clonic movements.
Syncope may result from cardiac and cerebrovascular disorders, hypoxemia, and postural changes in the presence of autonomic dysfunction. It may also follow vigorous coughing (tussive syncope) and emotional stress, injury, shock, or pain (vasovagal syncope, or common fainting). Hysterical syncope may also follow emotional stress but isn't accompanied by other vasodepressor effects.
Reference : A professional Guide to Signs and symptoms
|
| DrAlex_76
Forum Guru
Topics: 120
Posts: 410
|
syncope dun have clonic jerk , if yes then it goes to " seizure "
so A is the right one.
|
| Eagle_303
Forum Guru
Topics: 77
Posts: 655
|
DrAlex_76 wrote:
syncope dun have clonic jerk , if yes then it goes to " seizure "
so A is the right one.
I have quoted the reference that even in syncopy this clonic jerks can happen due to hypoperfusion of the brain.
Please come up with reference that in syncopy seizures cannot occur .
Another Referenc:
The depth and duration of unconsciousness vary. Sometimes the patient remains partly aware of the surroundings, or there may be complete unresponsiveness. The unconscious patient usually lies motionless, with skeletal muscles relaxed, but a few clonic jerks of the limbs and face may occur. Sphincter control is usually maintained, in contrast to a seizure. The pulse may be feeble or apparently absent, the blood pressure low or undetectable, and breathing may be almost imperceptible. The duration of unconsciousness is rarely longer than a few minutes if the conditions that provoke the episode are reversed
Harrison :Chapter 21 under syncope Edition 17th
Best of luck
Edited by Eagle_303 on 08/18/08 - 10:36 PM
|
| DrAlex_76
Forum Guru
Topics: 120
Posts: 410
|
ops...thats really new to me ...
|
| ngaybinhyen
Forum Guru
Topics: 23
Posts: 657
|
I hope everybody agrees this is a tricky question. While I agree with what Eager has pointed out, I personally don't think clonic jerk is considered as consistent with neurocardiogenic syncope. In reality, if we see a patient with syncope + clonic jerk --> seizure until proven otherwise
I would go for A. It could be E if they don't want me to be correct.
Please comment
-t.
|
| Eagle_303
Forum Guru
Topics: 77
Posts: 655
|
ngaybinhyen wrote:
I hope everybody agrees this is a tricky question. While I agree with what Eager has pointed out, I personally don't think clonic jerk is considered as consistent with neurocardiogenic syncope. In reality, if we see a patient with syncope + clonic jerk --> seizure until proven otherwise
I would go for A. It could be E if they don't want me to be correct.
Please comment
-t.
It seems as we are in a state of denial .
Cecil says:
During the Event
What events do witnesses describe as occurring during the episode of unconsciousness? Although body stiffening and limb jerking are well-known motor phenomena occurring during the loss of consciousness associated with generalized seizures, very similar motor movements can result from cerebral hypoperfusion. These motor movements occur especially if cerebral blood flow is not rapidly restored by termination of an arrhythmia or by falling to a recumbent posture in the setting of reflex or vasovagal syncope. Such muscle jerking is often multifocal and can be synchronous or asynchronous. In contrast to epileptic seizures, which generally produce tonic-clonic activity for at least 1 to 2 minutes ( Chapter 426 ), muscle jerking in syncope rarely persists longer than 30 seconds. If an arrhythmia continues or the patient is physically maintained upright (e.g., fainting in a phone booth or while sitting on a toilet), tonic stiffening of the body takes place (i.e., opisthotonos) and is followed by jerking movements of the limbs. Occasionally, motor movements identical to a tonic-clonic seizure occur, and a mistaken diagnosis of epilepsy can be made. Urinary incontinence during the spell is frequently used to support or refute a diagnosis of epilepsy; however, fainting with a full bladder can result in incontinence, whereas seizures with an empty bladder will not. Tongue biting favors seizures.
|
| arlete
Lucky woman!
Topics: 49
Posts: 3,465
|
Well... here is the thing: the LOC lasted 3 minutes, which is too long for a neurocardiogenic syncope,but it doesn't say how long the jerky movements lasted. According to Eagle's reference, this information would help us decide between A and E.
___________________
Now it's on God's hands. I've done my best!
|
| Ivonne
Find a way or make one
Topics: 58
Posts: 1,654
|
Neurologic events are common during episodes of neurocardiogenic syncope, according to the results of a study of tilt table testing published in the Sept. 8 issue of the Archives of Internal Medicine. The authors suggest that this diagnosis should be considered for unexplained seizure-like activity.
"Failure to identify the cause of clinical seizures is not uncommon and may lead to therapies that are ineffective and potentially harmful," write Rod Passman, MD, MSCE, from Northwestern University in Chicago, Illinois, and colleagues. "Misdiagnosis may result in a failure to prescribe appropriate therapy and could expose the patient to the risks of recurrent syncope and possible sudden cardiac death."
E
This patient should undergo the Tilt table testing...
___________________
"Believe you can and you're half way there."
|
| arlete
Lucky woman!
Topics: 49
Posts: 3,465
|
I am changing my answer to E.
___________________
Now it's on God's hands. I've done my best!
|
| DrAlex_76
Forum Guru
Topics: 120
Posts: 410
|
so nightflight, could u let us know where the Q comes from ?
|
| nightflight1945
banned
Topics: 32
Posts: 920
|
Let's end the fray ,
The correct answer is E!
|
| ngaybinhyen
Forum Guru
Topics: 23
Posts: 657
|
I'm convinced E
|
| arlete
Lucky woman!
Topics: 49
Posts: 3,465
|
Thanks for the nice question, night flight! 
___________________
Now it's on God's hands. I've done my best!
|
| nightflight1945
banned
Topics: 32
Posts: 920
|
GL arlete , have a nice match!
|
| arlete
Lucky woman!
Topics: 49
Posts: 3,465
|
Thanks!
___________________
Now it's on God's hands. I've done my best!
|
|
| |
| | | | | | | | | | | | | | | | | |
