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Spells. Differential diagnosis and management strategies
1Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York, USA.
Emergency Medicine Clinics of North America
|August 1, 1997
Summary
Differentiating between syncope and seizures is crucial for patients with spells of unknown origin. A thorough history and physical exam diagnose most cases, guiding targeted testing to avoid unnecessary procedures.
Area of Science:
- Neurology
- Emergency Medicine
Background:
- Spells of unknown cause present a diagnostic challenge in emergency medicine.
- Distinguishing between syncopal episodes and seizures is critical for appropriate management.
Purpose of the Study:
- To outline an effective approach for diagnosing patients presenting with spells of unknown origin.
- To emphasize the importance of a targeted diagnostic strategy.
Main Methods:
- Review of diagnostic approaches for spells of unknown cause.
- Emphasis on clinical history and physical examination findings.
- Guidance on selecting appropriate diagnostic tests based on presentation.
Main Results:
- History and physical examination yield the diagnosis in approximately 85% of cases.
- A directed, tailored approach to testing is more effective than a broad "shotgun" method.
- Some cases remain undiagnosed despite comprehensive workup.
Conclusions:
- Prioritize differentiating syncope from seizures in patients with unexplained spells.
- Utilize history and physical exam as primary diagnostic tools.
- Ensure life-threatening conditions are ruled out and arrange appropriate follow-up care.