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[Differential diagnosis of acute consciousness disorders]
P Greminger1, R Candinas, R Maire
1Departement für Innere Medizin, Universitätsspital Zürich.
Insights
Understanding syncope and coma is crucial for diagnosis. While many causes are identifiable through history and examination, cardiac syncope warrants further investigation due to higher mortality risks.
Area of Science:
- Neurology
- Cardiology
- Internal Medicine
Context:
- Syncope and coma are common yet complex neurological emergencies.
- Differential diagnosis requires careful consideration of various underlying pathologies.
Purpose:
- To outline the primary causes of syncope and coma.
- To guide diagnostic strategies for these conditions.
Summary:
- Syncope causes include cardiac, vascular, or cerebral issues, with diagnosis often established via history, physical exam, and ECG monitoring.
- Coma causes involve metabolic disorders, intoxication, or cerebral diseases, typically identified through basic tests and neurological assessment.
- A significant percentage of syncope cases remain undiagnosed.
Impact:
- Highlights the importance of targeted diagnostic approaches, especially for high-risk cardiac syncope.
- Emphasizes the need for thorough evaluation in undiagnosed syncope and coma cases.
- Aids clinicians in efficiently diagnosing and managing patients presenting with syncope or coma.
Abstract:
The most important causes of syncope and coma are discussed. Syncope may be due to cardiac, vascular or cerebral disease. A cause of syncope is not established in up to 50% of cases. Where a diagnosis is possible the patient's history, physical examination, ECG and prolonged ECG monitoring serve to establish the underlying disease in most cases. Additional diagnostic tests should only be performed in patients with possible cardiac syncope, since these cases show a higher mortality rate than patients with non-cardiac syncope. Coma may be caused by metabolic disorders, intoxication or cerebral diseases, which are easily identified by history, physical examination and simple laboratory tests in most cases. Further evaluation of patients with unknown cause of coma depends on whether focal neurologic signs, meningeal irritation and fever are present.