 |
       |
|
|
FAINTING -IS IT A NEUROLOGICAL SYMPTOM ?
OP Kapoor
Ex. Hon. Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
An attack of fainting does not call for a neurological consultation. The reasons are as follows:
I.If the attack of fainting has occurred at rest and that too for the first time in life, exclude:
a. Cardiac emergencies like an attack of arrhythmia or a silent myocardial infarction.
b. Lung emergency like Pul. embolism if the patient had the slightest complaint of pleural pain or tachypnoea.
c. Gastro-intestinal emergency like upper GI bleed. Also look out for melaena or examine the gastric aspirate.
II.If fainting occurs on exertion, exclude:
a. Congenital obstructive cardiac outlet diseases like pulmonary or aortic stenosis
b. Postural hypotension
c. TIA of the brain stem
III.If the syncope has occurred during the attack of
a. Severe bronchitic cough, consider "cough" syncope.
b. If the fainting has occurred while passing urine in the middle of the night, consider "micturition" syncope.
c. If fainting has occurred while sneezing violently, consider "sneezing" syncope.
IV.The most common cause of syncope is vasovagal attack due to a fright or a bad news or a shock. The second most common cause is sick sinus syndrome which is suspected because of the slow pulse rate and can be confirmed by Electro-Physiological studies of the heart.
Vaso-depressive syncope which is confirmed by Head Tilt Up Test and where a small dose of Betablockers can prevent recurrence is the third most common cause.
Insulin or even large doses of oral anti-diabetic drugs can cause fainting in a diabetic patient.
Since above are the causes of fainting, the role of a Neurologist does not come and neurological causes should be considered as a rare cause. Yet there are patients where no cause is detected and these are considered as "idiopathic". In these cases a neurologist may be consulted for the satisfaction of the patient, because the patients associate the attack of fainting with the "brain" (as many GPs do)!
 |