You have been called to a public bus station for a behavioral emergency. On scene, you find a disheveled male in his forties sitting up against a wall. He is confused and incontinent. Bystanders state that he was just sitting on a bench watching people walk by, when suddenly he got up and began to stumble around, shouting obscenities, and then fell to the ground shaking. From this description, the EMT should be suspicious of which condition?

Syncope and seizures are two of the most common differential diagnoses for transient loss of consciousness.  Syncope is characterized by a sudden, complete loss of consciousness, with rapid recovery. Syncope, or fainting, is caused by low blood pressure resulting in an insufficient supply of blood, and therefore oxygen, to the brain. Some symptoms of syncope include: Orthostatic hypotension, Simple faints, Episodes that only occur in the recumbent position, and Syncope induced by strong emotional stimuli.  Seizures can be epileptic or non-epileptic. Some symptoms of seizures include: A... Show more

Syncope and seizures are two of the most common differential diagnoses for transient loss of consciousness. 

Syncope is characterized by a sudden, complete loss of consciousness, with rapid recovery. Syncope, or fainting, is caused by low blood pressure resulting in an insufficient supply of blood, and therefore oxygen, to the brain. Some symptoms of syncope include: Orthostatic hypotension, Simple faints, Episodes that only occur in the recumbent position, and Syncope induced by strong emotional stimuli. 
Seizures can be epileptic or non-epileptic. Some symptoms of seizures include: A sensation of fear, Olfactory or gustatory hallucinations, Visceral or déjà vu sensations, and Focal motor or sensory phenomena. 
Some causes of syncope include: Vasovagal reflexes, Decreased cardiac output, Vertebrobasilar ischemia, Cardiac arrhythmias, and Outflow obstruction. 
In order to differentiate between syncope and seizure, videotelemetry with simultaneous electroencephalographic (EEG) and electrocardiographic (ECG) recording with multiple scalp and chest electrodes is required. 
Diagnostic testing for seizures includes: Laboratory testing, CT scan, Lumbar puncture, MRI, and Electroencephalogram (EEG). 

Related Test: Prehospital Emergency Care Practice Test: Handling Altered Mental Status, Stroke, and Headache

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