Postural tension loss

Introduction Symptomatic hypotension can have sudden, transient loss of consciousness with the disappearance of postural tension, which is the occurrence of syncope. Syncope refers to a sudden loss of transient consciousness caused by a sudden, widespread, insufficient blood supply to the brain. It is caused by physical factors and can also be secondary to blood circulation disorders in the brain. Its clinical features are acute onset and loss of transient consciousness. Patients often have prodromal symptoms about one minute before the onset of syncope, manifested as general discomfort, blurred vision, tinnitus, nausea, pale, cold sweat, limb weakness, and soon syncope. At the onset of syncope, casual exercise and loss of sensation, sometimes apnea, slow heart rate, and even cardiac arrest, it is difficult to touch the radial artery and the carotid artery. Neurological examination can reveal dilated pupils, loss of light reflection and corneal reflexes, reduction or disappearance of sputum reflexes, pathological reflexes, often accompanied by salivation and urinary incontinence. It usually lasts for 2-3 minutes, and all functions are gradually restored. After the patient wakes up, there may be a short period of conscious turbidity, abdominal discomfort, nausea, vomiting, constipation, even incontinence, extreme fatigue, lethargy, duration of a few minutes to half an hour, after the onset of examination can be no positive signs.

Cause

Symptomatic hypotension: When the systolic blood pressure is as low as 13.4 to 9.3 kPa (100 to 70 mmHg), most people's cerebral blood flow perfusion can be ensured by self-regulation mechanism; however, when the systolic blood pressure is less than 9.3 kPa (70 mmHg), There is no guarantee of minimal blood flow perfusion required for normal brain activity and cerebral ischemia. The light can be corrected, the heavy one is easy to become irreversible, and the prognosis is poor.

an examination

Related inspection

EEG dynamic electrocardiogram (Holter monitoring)

Symptomatic hypotension can be seen. In severe cases, sudden and transient loss of consciousness can be accompanied by the disappearance of postural tension, which is the occurrence of syncope. The prodromal symptoms of syncope are:

1 Dizziness, dizziness, and discomfort after excessive physical or mental work.

2 After dizziness, blurred vision, vertigo, and black eyes soon appeared.

3 may have mild hearing loss or tinnitus.

4 weak and weak, standing unstable, have a desire to dump.

5 pale, nervous, and strenuous, even unable to speak.

6 can be accompanied by nausea, vomiting and other gastrointestinal symptoms.

7 Most patients do not have time to support the support or immediately take the position, the seat will immediately faint and fall.

A considerable number of patients were fainted when no one was present. Some patients may have facial or head skin abrasions, the elderly may be fractured due to falling, or may have a sudden decrease in blood pressure and a cerebrovascular accident or acute myocardial infarction, etc., some elderly people may suffer from cold for a long time after fainting Pneumonia. Except for cardiogenic and neurogenic (central) sexually, there was no significant change in breathing, heart rate could be slower and faster, heart sounds were lower and weaker; deep and shallow nerve reflexes existed (unlike coma). The patient can clearly describe the situation before the syncope or the environment in which it is located. The general attack is from ten to ten minutes, rarely more than 20 minutes. After the patient is awake, there are still pale, sweaty, cold hands and feet, and unable to talk. A small number of people who have not had a long time of fainting and have no serious trauma or comorbidity can go to a nearby medical unit automatically or under the support of others. At this time, there are no obvious abnormal findings; only those with primary organic diseases that cause syncope still The corresponding positive signs can be checked.

Differential diagnosis

It is not difficult to identify symptoms such as syncope and dizziness and falls. However, epilepsy and syncope have a transient loss of consciousness, which is sometimes confusing in the clinic. For a long time, patients can be identified by using EEG on epileptic discharge or sharp wave or spine-slow wave. If the EEG is abnormal, the diagnosis is difficult, and sometimes the witness's description is important. Refer to the following clinical features:

1 Limb twitching in patients with epilepsy occurs before or at the same time as loss of consciousness. The convulsions last for a long time. In patients with syncope, convulsions occur more than 10 minutes after loss of consciousness, in the form of generalized convulsions and short duration.

2 epileptic seizures have nothing to do with postural changes and situations, regardless of the time of the occasion. Loss of consciousness induced by pain, exercise, urination, emotional stimulation, special posture, etc. often suggests syncope.

3 The loss of paroxysmal consciousness with symptoms such as sweating and nausea often suggests syncope rather than epilepsy.

4 After seizures, there is often a state of confusion, ranging from a few minutes to a few hours. Some patients have lethargy or mental confusion after the attack. After the onset of syncope, the consciousness recovered more quickly and there was less mental disorder.

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