While staying in a stuffy room a 19-year-old emotionally labile girl developed severe weakness, dizziness, blackout, nausea and loss of consciousness without convulsions. Objectively: the patient is unconscious, the skin is pale, extremities are cold. AP - 90/60 mm Hg, Ps- 96/min, deficient, breathing is shallow. Pupillary and tendon reflexes are present. There are no pathological signs. What is the most likely diagnosis?

Answer options

1. Hysterical neurosis
2. Vegetovascular paroxysm
3. Transient ischemic attack
4. Epileptic attack
5. Syncope

Explanation

While staying in a stuffy room a 19-year-old emotionally labile girl developed severe weakness, dizziness, blackout, nausea and loss of consciousness without convulsions. Objectively: the patient is unconscious, the skin is pale, extremities are col d. AP – 90/60 mm Hg, Ps- 96/min, deficient, breathing is shallow. Pupillary and tendon reflexes are present. There are no pathological signs. What is the most likely diagnosis?Syncope may be defined as a transient loss of consciousness due to global cerebral hypoperfusion with rapid onset, short duration, and spontaneous complete recovery. Note how this definition excludes other causes of collapse such as epilepsy. The European Society of Cardiology published guidelines in 2009 on the investigation and management of syncope. They suggested the following classification: Reflex syncope (neutrally mediated)vasovagal: triggered by emotion, pain, or stress. Often referred to as 'fainting'situational: cough, micturition, gastrointestinalcarotid sinus syncopeOrthostatic syncopeprimary autonomic failure: Parkinson's disease, Lewy body dementiasecondary autonomic failure: e.g. Diabetic neuropathy, amyloidosis, uremiadrug-induced: diuretics, alcohol, vasodilatorsvolume depletion: hemorrhage, diarrheaCardiac syncopearrhythmias: bradycardias (sinus node dysfunction, AV conduction disorders) or tachycardias (supraventricular, ventricular)structural: valvular, myocardial infarction, hypertrophic obstructive cardiomyopathyothers: pulmonary embolismReflex syncope is the most common cause in all age groups although orthostatic and cardiac causes become progressively more common in older patients. Evaluationcardiovascular examinationpostural blood pressure readings: a symptomatic fall in systolic BP > 20 mmHg or diastolic BP > 10 mmHg or decrease in systolic BP < 90 mmHg is considered diagnosticECGcarotid sinus massagetilt table test24-hour ECG