Clinical Case Database / Category: Patient Management
Fits, faints & funny turns
Publication details
Rajiv Mohanraj PhD, FRCP, Sada Chaudhry
Foundation Years Journal, volume 8, issue 3, p.30 (123Doc Education, London, March 2014)
Abstract
‘Fits, faints and funny turns’ describe often dramatic and frightening symptoms and are common reasons for people to seek medical attention. These terms usually refer to a period of transient loss of consciousness. The underlying diagnosis of transient loss of consciousness is often inaccurate or delayed. Patients may falsely be labelled as having a diagnosis of epilepsy and consequently other potentially life threatening diagnoses may be missed. Foundation year doctors are often the first people to assess patients presenting with such symptoms, for example whilst clerking during the acute medical take, when reviewing ward patients during on call shifts, and whilst working in the Emergency Department or community. This assessment provides a great opportunity to utilise the key skills of being a doctor, including taking and performing a thorough history and examination, formulating a differential diagnosis, selecting appropriate investigations and presenting findings to senior colleagues.
The aim of this article is to discuss the differential diagnoses for patients presenting with transient loss of consciousness, and to highlight important features in history taking, examination, investigation and management.
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Authors
Rajiv Mohanraj PhD, FRCP
Consultant Neurologist / Honorary Lecturer
Greater Manchester Neurosciences Centre
Salford Royal NHS Foundation Trust
Stott Lane
Salford, M6 8HD
rajiv.m@doctors.org.uk
Sada Chaudhry
Consultant Neurologist
Department of Neurology
Wythenshawe Hospital
Manchester
sada.chaudhry@doctors.org.uk
References
1. National Institute for Health and Clinical Excellence, 2010, Transient loss of consciousness in adults and young people (CG109). London: National Institute for Health and Clinical Excellence.
2. Hadjikoutis S, O’Callaghan P, Smith PE. The investigation of syncope. Seizure 2004, 13:537-548.
3. Forsgren L, Bucht G, Eriksson S, et al. Incidence and clinical characterisation of unprovoked seizures in adults: a prospective population based study. Epilepsia 1996;37:224-29.
4. Smith D, Defalla BA, Chadwick DW. The misdiagnosis of epilepsy and the management of refractory epilepsy in a specialist clinic. QJM. 1999; 92: 15-23.
5. Smith PE. If it’s not epilepsy... J Neurol Neurosurg Psychiatry 2001, 70: 9-14.
6. Dreifuss FE. Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia. 1981, 22:249-260.
7. Benbadis S. The differential diagnosis of epilepsy: a critical review. Epilepsy and behaviour 2009, 15:15-21.
8. Murtagh J. Fits, faints and funny turns – a general diagnostic approach. Australian family physician 2003, 32(4):203-6.
9. Manford M. Assessment and investigation of possible epileptic seizures. J Neurol Neurosurg Psychiatry 2001, 70:suppl2, 3-8.
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About the Clinical Cases Database
The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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