# Atypical Vasovagal Syncope



## Handsome Rob (Jun 14, 2011)

"Hypothetical" here. Patient as follows:

25 y/o female of Jewish and African American descent (ethnic genetic causes possibly?), extremely fit, NKDA, no prior known health complications. 

Sitting in the passenger seat of a "car", patient states "oh sh*t" and hunches over, eyes open, but non-responsive to verbal stimuli. Upon palpation, the patient has muscle "tone", rigidity to the upper extremities and gasping respirations at 12-14. The patient remains in this state for 2 minutes or less. Upon arrival to the ED, the patient is carried into the ER and placed in a wheelchair. Once settled in the chair, the patient regains conciousness and declares that it happened again after being momentarily confused as to her surroundings. The patient is A&Ox4 within a minute and refuses medical care based on a history of atypical vasovagal syncope. For the next few hours the patient experiences nausea and weakness, but continues to deny medical intervention or evaluation.

My question is this: based on the "oh sh*t" remark and the nausea that followed I would be thinking seizure, however I cannot align all of the symptoms. Where do I start looking? I have found minimal info on atypical syncope (some sytptoms align, other disqualify) 

Kinda hits close to home and need some guidance here...

Unfortunately, this is all the info I can get right now (was not there, getting this from the person who was).


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## usalsfyre (Jun 14, 2011)

It's not unusual for vasovagal episodes to present with a brief tonic phase. In fact, probably 50% of witnessed vasovagal episodes I run are mistaken for seizures by those without (and some with) medical training. The easiest way to distingush is lack of a typical post-ictal phase (brief confusion doesn't really count).

2 minutes is kinda long for the tonic phase, is the bystander 100% sure it was this long?


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## Handsome Rob (Jun 14, 2011)

No he isn't. He was unable to give an exact time. I am under the impression that she regained conciousness and had a very short period of confusion lasting only seconds which would not be considered posttictal...


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## usalsfyre (Jun 15, 2011)

Handsome Rob said:


> No he isn't. He was unable to give an exact time. I am under the impression that she regained conciousness and had a very short period of confusion lasting only seconds which would not be considered posttictal...



Sounds VERY much like a syncopal episode. He really shouldn't be driving until that gets explained though...


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## George4 (Jul 2, 2011)

In a sitting position, one wouldn't quickly regain consciousness as most do when they hit the ground after a vasovagal syncopal.  Syncope is nature's way of putting your body into a position for easy reperfusion of the brain.  And I guess if one is sitting down, the reperfusion would take a bit longer, with a slightly delayed period of confusion.  Doesn't explain the muscle rigidity tho... That's a tricky one.


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## mycrofft (Jul 3, 2011)

*Diagnose and assess, treat to match.*

An "upper body seizure" sounds fishy, but they could still be sick. Vasovagals usually "do the funky chicken" as they come out of it without a true postictal.
Any unexplained syncope at the wheel or sitting down ought to be reported to the DMV.


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