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Friday, 29 November 2013

Fainting (Syncope) - Misdiagnosis

Fainting also known as Syncope of "black out" is defined as a condition of sudden loss of consciousness followed by the return to full wakefulness in a short duration as a result of  abnormally low blood pressure. In most cases, it is caused by hypotension, with blood pressure that's lower than 90/60 mmHg.(1). Even though Low blood pressure has mainly been regarded as good health for people who exercise, but recent studies have indicated an association with depression in elderly people. there are epidemiological evidence for an association of low blood pressure with anxiety and depression, which is not caused by cardiovascular disease.(2). In some case, severely low blood pressure can seriously impair adequate blood flow to vital organs and a life-threatening condition called shock.

In the Part 1 of two-part unit outlines. Dr. Meyer A. indicated that the various possible causes of transient loss of consciousness (blackouts), the importance of accurate diagnosis and the impact of misdiagnosis. It also discusses the establishment of specialist clinics in order to help with diagnosis and management.
(22) Other researchers suggested that Syncope is much more common than epilepsy and may present with symptoms akin to the latter. This fact is not well appreciated and often leads to misdiagnosis.(23)
A. Misdiagnosis
1. Seizure
Neurocardiogenic syncope (NCS) can be mistaken as a seizure. Scientists at the Capital Health Authority found that NCS is commonly misdiagnosed as epilepsy. Some patients had an incorrect diagnosis for > 10 years. Patients with this misdiagnosis are often excessively investigated, inappropriately treated, and have unnecessary restrictions placed on driving and employment(24)

2. Cardiac arrest
In the report of presents two patients, both known to have cardiac disease, with implanted cardiac devices, who presented with loss of consciousness, who were initially investigated for epilepsy, but were subsequently shown to have had a cardiac arrhythmia, diagnosed following device interrogation.(25)

3. Status cataplecticus 
A 76-year-old patient, since the age of 45, presented with frequent attacks often triggered by emotional stimuli and characterised by forward head drop and a fall to the ground without loss of consciousness. Status cataplecticus misdiagnosed as recurrent syncope(26)

4. Etc.
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Sources
(1) http://www.nhlbi.nih.gov/health/dci/Diseases/hyp/hyp_whatis.html  
(2) http://www.ncbi.nlm.nih.gov/pubmed/17183016
(22) http://www.ncbi.nlm.nih.gov/pubmed/19331078
(23) http://www.ncbi.nlm.nih.gov/pubmed/17068273
(24) http://www.ncbi.nlm.nih.gov/pubmed/17598602
(25) http://www.ncbi.nlm.nih.gov/pubmed/19728521 
(26) http://www.ncbi.nlm.nih.gov/pubmed/18175082