RECOGNIZING SYNCOPE - PITFALLS AND SURPRISES

Loss of consciousness and falling are the key features of syncope. Com mon accompaniments include tonic and myoclonic muscle activity, eye de viations, automatisms, vocalizations and hallucinations which may rend er the distinction from epileptic seizures difficult. Differential dia gnosis is based on the specific features and not the mere presence of these phenomena. Recognition of syncope depends also on accurate infor mation about precipitants, premonitory symptoms and postictal events: the absence of postictal confusion has been identified as the single m ost powerful factor discriminating syncope from epileptic seizures whe reas incontinence and head injury are common in both conditions, inves tigations such as electroencephalogram, tilt testing and posticial pro lactin or creatine kinase levels may he helpful but are never diagnost ic in isolation, Exceptionally, hypoxic and epileptic mechanisms inter act within a single attack.