Spells. Differential diagnosis and management strategies.
In summary, when approaching the patient who has had a spell of unknown cause, the most important differentiation to make is between a syncopal episode and a seizure. The history and physical examination will provide the diagnosis in approximately 85% of cases. Once the physician has some idea of which path to pursue, it is important to order the tests in a directed fashion tailored to the patient's presentation. A shotgun approach is neither warranted nor beneficial and is best avoided when possible. Some patients will remain without a diagnosis despite a complete workup, thus it is important for the emergency physician to rule out the life-threatening possibilities and to arrange the appropriate long-term follow-up for the patient with their primary care provider.
Preblick-Salib
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Department of Emergency Medicine, Mount Sinai School of Medicine, New York, New York, USA.
Jagoda
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A
D002561:Cerebrovascular Disorders / Q000150:complications; D003221:Confusion / Q000175:diagnosis / Q000209:etiology; D003937:Diagnosis, Differential; D006801:Humans; D008487:Medical History Taking; D010808:Physical Examination; D012640:Seizures / Q000150:complications / Q000175:diagnosis*; D013575:Syncope / Q000175:diagnosis* / Q000209:etiology