Syncope or seizure or even other types of transient loss of consciousness ? A differential-diagnostic challenge

Abstract

Background: Syncope and seizure are the most common clinical manifestations of transient loss of consciousness (TLOC). The differential diagnosis may be quite difficult and often causes misdiagnoses with consequently inappropriate treatment attempts. TLOC defines the various, rather frequent conditions with an abrupt onset of apparent loss of consciousness. Within a short time (i.e. within minutes), patients have a spontaneous and complete recovery. During TLOCs there is: 1) loss of normal motor control either with flaccid muscle tone or with stiffness that may be accompanied by jerking movements, 2) loss of postural control associated with falls, and 3) unresponsiveness and amnesia for the time period of the event. It is of clinical importance to establish the cause of TLOC. The most common causes of non-traumatic TLOC are syncope and seizure. While differentiation between these two causes has significant therapeutic consequences, it is often difficult, particularly if patients have a convulsive syncope. The following are ways to recognize causes of TLOC.