Vertigo/Syncope

Can be encountered as two clinical situations

1. A patient himself reporting with a history of giddiness which occurred a few minutes earlier or in the immediate past. Consider

• Syncope

• Vertigo

• Seizure

• Transient ischemic attack (Vertebrobasilar insufficiency)

​2. A patient brought comatose with a history of giddiness and fall. Consider

• TIA (vertebrobasilar)

• - Seizure
• – Stroke
• Common Causes of Syncope Vasovagal syncope

• On prolonged standing Postural syncope (syncope on getting up from sitting/lying posture)

• Volume depletion

• Diarrhea/vomiting/blood loss/urinary loss/excessive sweating

• Drugs causing vasodilatation and antihypertensives
• After prolonged bed rest
• Peripheral neuropathy
• Severe anemia Cardiac causes of syncope (Can be postural, exertional or even at rest)
• Arrhythmias
• AV block (Stokes-Adams attacks)
• Acute MI
• AS, HOCM, Primary Pulmonary hypertension (PPH), Pulmonary stenosis (Exertional syncope) Miscellaneous:
• Cough syncope in chronic bronchitis
• Micturition syncope
• Carotid sinus hypersensitivity
• Hypoglycemic episodes
• Hyperventilation syndrome Severe anemia can precipitate postural and exertional syncope