La valutazione neurologica e La valutazione neurologica e psichiatrica nel paziente psichiatrica nel paziente con perdita di coscienza con perdita di coscienza Giuseppe Micieli Dip Neurologia d’Urgenza IRCCS Fondazione Ist Neurologico Nazionale C. Mondino Pavia
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La valutazione neurologica e psichiatrica nel paziente con perdita di coscienza Giuseppe Micieli Dip Neurologia dUrgenza IRCCS Fondazione Ist Neurologico.
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La valutazione neurologica e La valutazione neurologica e psichiatrica nel paziente con psichiatrica nel paziente con
perdita di coscienzaperdita di coscienza
Giuseppe MicieliDip Neurologia d’Urgenza
IRCCS Fondazione Ist Neurologico Nazionale C. MondinoPavia
Misdiagnosis of epilepsy in three Misdiagnosis of epilepsy in three population-based and three cohort studies population-based and three cohort studies of patients with presumed seizure disorderof patients with presumed seizure disorder
The value of history for The value of history for distinguishing seizure from distinguishing seizure from
syncopesyncope
mod from: Hoefnagels WA et al. J Neurol 1991;238:39-43mod from: Hoefnagels WA et al. J Neurol 1991;238:39-43
Classification of syncopeClassification of syncope
• Origin and strenght of stimulus• Set point of the reflex• Input from higher centres• Responsiveness of cardiovascular receptors and organs• Neurohumoral and vasoactive substances• Interactions of the aortocarotid with chemoreflex arc
MSA
PD PAF
Syncope & FallsSyncope & Falls
30% cognitively normal elderly people are unable to
recall documented falls three months later
50% a withness account for syncopal events unavailable
40% of patients with an attributable diagnosis of carotid
sinus syndrome, the only presenting symptoms were falls alone or falls with dizzines (syncope was denied)
20% Amnesia for loss of consciounsness demonstrated in patients with a diagnosis of carotid sinus syndrome
FE Shaw and RA Kenny, 1997
Alsaadi TM, Vinter Marquez A. Am Fam Physician 2005;72:849-856
Features suggesting a diagnosis Features suggesting a diagnosis of psychogenic nonepileptic of psychogenic nonepileptic
seizuresseizures
Alsaadi TM, Vinter Marquez A. Am Fam Physician 2005;72:849-856
NeurologicNeurologicalal
and and PsychiatricPsychiatric and and PsychiatricPsychiatric