Blackouts and ‘funny turns’ present very commonly to general practice and can be confusing to sort out. This chapter is an overview of common presentations which will help you make sense of them. They are common and serious in the elderly, but all ages are considered in this chapter.
It is useful to think of these problems in three categories:
Blackouts
Blackouts can mainly be subdivided into syncope and seizures, of which the former are common and the latter unusual in practice. The diagnosis relies on the history which is usually straightforward with a careful history from both patient and any witnesses. Table 33.1 compares the key features of each; differentiating fit from faint is an important first step in management.
Syncope
Syncope has a multitude of causes which may be difficult to disentangle. In children and young people it is common and usually vasovagal in origin, provoked by intercurrent infection, standing up suddenly and emotions (the first visit to the operating theatre for some medics). An accurate diagnosis needs to be made, particularly for those children who twitch when they faint and who are at risk of a misdiagnosis of epilepsy. In elderly people blackouts are common and have a multitude of causes. Although benign in themselves, the injuries they cause can be fatal (e.g. fractured hip, head injuries). A good history from both patient and witnesses is crucial. It is important, particularly in elderly people, to find out whether there was a blackout (unconsciousness) or a conscious fall – this can be surprisingly hard to tease out.
The more common causes can be grouped together as:
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