Evaluation of the patient with spells

: The neurologic consultant is frequently called to evaluate the patient with transient neurologic deficits, or spells. Spells can present with a broad array of clinical features, making a systematic evaluation challenging. Familiarity with a variety of key features for different spell types will help the consultant create an appropriate differential diagnosis to guide the diagnostic evaluation.

: Recent practice parameters outline the appropriate evaluation for patients presenting with first unprovoked seizure, and an update in the International League Against Epilepsy classification scheme for seizures has shifted the terminology used to describe these spells. When a spell cannot be unambiguously identified as a seizure, recent studies propose features to help distinguish syncope, sleep disorders, and psychogenic nonepileptic seizures. For patients who are critically ill, extended EEG monitoring is increasingly available, and there is a growing appreciation for the high burden of seizures and status epilepticus in the intensive care unit population.

: This article reviews the most common paroxysmal spell types encountered on the acute care ward and in the intensive care unit, discusses clinical features that help distinguish various spell types, and proposes a systematic evaluation for use by the neurologic consultant.