The evaluation of spells

The differential diagnosis of spells is broad and includes both innocent and life-threatening conditions with a considerable overlap in clinical presentation. Extensive diagnostic testing is often performed, without reaching a final diagnosis, or resulting in false-positives. A thorough medical history, including family history and medication, and physical examination are required to obtain clues about the cause of a spell. An overview of spells with their stereotypic phenotype in general internal medicine practice is presented in this article. Besides, a diagnostic approach is proposed for the clinical evaluation of spells.