Abdullah TawakulR2 NeurologyIntroductionThe assessment of a patient with a transient loss of consciousness can be difcult . These patients fall into two groups: those with seizures which embrace both epileptic and non!epileptic e"ents .IntroductionAnd those with syncope de#ned as loss of consciousness and postural tone caused by cerebral hypoperfusion with spontaneous reco"ery . IntroductionThere can also be the confounding factor of con"ulsi"esyncope which is a seizure!like reaction resulting fromglobal cerebral hypoperfusion$ this happens in around%2& of patients presenting with syncope'Introduction(n presentation "ital clues are commonly missing because patients may ha"e amnesia and a witness account might not be a"ailable and e"en after multiple in"estigations a diagnosis may still be not be possible .)eizure **+ : )yncope **+ :,linical approach ..It-s all in the history,linical history and e+amination.istorical features are "ery essential in distinguishing syncope from seizures and ha"e been proposed as a scoring scheme /table0 by )heldon and colleagues . This point score is a useful bedside tool is based on symptoms only and diagnoses seizures with 12& sensiti"ity and speci#city .3"ents prior to the attack3"ents prior to the attack3"ent at the onset of the attack3"ent during the attack3"ent during the attack3"ents after the attackAntecedent disorders,linical e+am :4ital signs ''orthostasisNeurological e+am 55,4) e+am '(6Its tricky ..lets do MRI or PET scan?In"estigations7anagement of the patients should not beguided by the specialty under which they wereadmitted8eg a patient admitted under neurology only ha"ing neurological in"estigations'(ne study of clinical!decision making has shown that internists tended toward a broader diagnostic assessment than their cardiology colleague'In"estigations6asic laboratory in"estigations should be done toe+clude anaemia infection electrolyte disturbances orrenal and li"er dysfunction .39: /cardiac work up0* dimer''4; scanIn"estigations33: and telemetry :,linicalsuspicionabnormal mo"ementsfunny turns'

In one 6ritish study of electroencephalogram use in a district hospital uenced management'In"estigationsNeuroimaging :

reser"ed for patients presenting with a suspected #rstunpro"oked seizure or with a focal neurologicalde#cit' ReferencesHistorical criteria that distinguish syncope from seizures.. )heldon et'al .Seizure versus syncope .. McKeon et.al .Falls, faints, fts and funny turns.. Thi?s et'al .Making the diagnosis in patients with blackouts it!s all in the history.. @lug et'al