Important points to glean from a history of syncope:
ask an observer to describe attacks
generally the patient has some warning sensation of faintness, blurring of vision, dizziness or nausea
if patient loses consciousness, then they are generally unconscious before hitting the ground
syncope as a result of orthostatic hypotension occurs only when the patient is sitting or standing at the time of onset
generally the patient is only unconscious for a short period of time unless the patient is sat up, resulting in more prolonged cerebral hypoxia
convulsions are uncommon in syncope unless the patient is sat up, in which case the seizure is a reflex response to cerebral hypoxia
the patient rapidly becomes orientated once consciousness is regained, this is in contrast with the confusion following an epileptic seizure
if syncope is as a result of palpitations, then these occur at the start of the episode
patients with parkinsonism or diabetes are prone to the development of postural hypotension; this is also true of patients taking hypotensive medication e.g. diuretics
incontinence and tongue biting are uncommon in syncopal attacks but are more common in epileptic seizures
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