“TOP TIPS”BLACKOUTS
Dr Siân Price
Consultant Neurologist, Sheffield
Teaching Hospitals
Blackouts
 What do they mean?
 Take a detailed History
 Witness account
 Loss of consciousness?
 Loss of awareness?
 Something else? Sleep? Dizzy? Visual loss?
 NICE Guidelines
Loss of consciousness -Syncope
 Hot, lightheaded. Standing, grey out of vision and
fading of hearing, floppy to floor, often pale. Rapid
recovery ( if lying), brief <2mins. May twitch a bit. Refaint on re-standing?, hearing back first.
 Clear provocation and a one off, examine, postural
BP, ECG and safety advice.
 No clear provocation, recurrent. As above and
consider bloods FBC, U+E, Glucose, 9am cortisol. If
ECG abnormal or “red flags” refer to cardiology. If
significant postural drop consider referral to syncope
clinic ( or endocrine if results suggest Addison's)
Loss of consciousness- refer to
cardiology?
 Red Flags
 Family history of sudden death
 Age >65
 Chest pain, palpitations, exercise induced or sitting
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with light headed feeling or syncope.
Prolonged recovery?
Abnormal ECG ( QTc?), arrhythmia?, (heart block,
WPW, LGL)
Murmur, ischaemic heart disease or cardiac failure
Consider echocardiogram and 24 hour tape
Loss of consciousness- Refer to
Neurology
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Epilepsy?
Possible status epilepticus ? 999, Neurology afterwards.
At start :- Warning?, Automatisms? Posturing?
Stiff, noisy breathing, odd colour ( desaturating), jerking, eyes
often open, may deviate.
Prolonged post ictal phase and confusion
Bite is usually side tongue, (wetting only means loss of
consciousness).
Mixed type of attacks
Stop and stare?
Vacant with automatisms and or confusion
Myoclonic jerks
Odd blackouts ? Fits or not?
Loss of consciousness- No
markers or witnesses
 Known heart disease refer to cardiology
 Otherwise refer to Neurology
Loss of awareness- Refer to
Neurology? ( or Peads if <16)
 Brief blanking+/- myoclonic jerks
 With automatisms, confusion, refer
to Neurology
 Could it be psycogenic?
Remember
 Can have twitching with syncope
 Fits with headache and fever- encephalitis?
 More brain tumours present with fits than
headache
 Around half of people having one fit will get
more. 1 in 100 or so will have a fit
 High level initial incorrect diagnosis- always
be prepared to think again.
 Always remember safety ( including for
syncope) and driving advice
Rotherham Neurology
 Outreach from Sheffield
 Although 4 consultants visiting we only make about 1
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and a bit FTE ( Siân Price, Ralf Lindert, Siva Nair,
Danute Kucinskiene ( locum)
Specialist Nurses outreach from Sheffield too (
Epilepsy, MS, Parkinson’s ( separate from Elderly
med), do clinics at Rotherham.
Some specialty services and tests done in Sheffield.
We have no Rotherham beds but see ward referrals.
2 WW via Sheffield
THANK YOU