Petkar Sanjiv, Cooper Paul, Fitzpatrick Adam P
Manchester Heart Centre, Manchester Royal Infirmary, Manchester, UK.
Postgrad Med J. 2006 Oct;82(972):630-41. doi: 10.1136/pgmj.2006.046565.
Daily in the UK, frontline medical and paramedical staff are required to manage patients with "collapse ?cause". This universal colloquialism refers to patients who have had an abrupt loss of postural tone. Some of these patients would have had a "blackout" or a transient loss of consciousness (T-LOC). The three most important causes of T-LOC are syncope, epilepsy and psychogenic blackouts. Determining the correct cause is an important challenge; if the initial clinical diagnosis is wrong, investigations may be misdirected, and the final diagnosis and treatment incorrect. 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. This article deals with the clinical features of the three main causes of blackouts, the value of investigations in arriving at a diagnosis and the problem of misdiagnosis. Pathways for managing patients presenting with blackouts are suggested.
在英国，一线医疗和辅助医疗人员每天都要处理“不明原因昏厥”的患者。这种普遍的通俗说法指的是那些突然失去姿势张力的患者。其中一些患者会出现“昏厥”或短暂意识丧失（T-LOC）。T-LOC的三个最重要原因是晕厥、癫痫和心因性昏厥。确定正确病因是一项重大挑战；如果初始临床诊断错误，检查可能会被误导，最终诊断和治疗也会不正确。晕厥比癫痫更为常见，且可能表现出与癫痫相似的症状。这一事实并未得到充分认识，常常导致误诊。本文探讨了昏厥的三个主要原因的临床特征、检查对诊断的价值以及误诊问题。文中还提出了处理昏厥患者的途径。
