RT Book, Section
A1 Victor, Jesse
A1 Beerepoot, Lucas
A2 Salardini, Arash
A2 Biller, José
SR Print(0)
ID 1127045726
T1 Spells, Not Epileptic or Vascular
T2 The Hospital Neurology Book
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 9780071845830
LK neurology.mhmedical.com/content.aspx?aid=1127045726
RD 2024/04/19
AB Episodes  that  involve  transient  alteration  in  the  level  of  consciousness  can  be  particularly  a  challenging  problem  faced  by  the  practicing  neurohospitalist.  Getting  a  good  history  is  key  in  neurology,  but  often  challenging  given  patient  factors  and  the  hospital  environment.  It  is  the  experience  of  the  authors  that  many  times  an  initial  evaluation  ensues  that  is  primarily  focused  on  “ruling  out”  vascular  or  epileptic  etiologies.  It  is  worth  noting,  however,  that  while  all  vascular  events  and  seizures  are  spells,  not  all  spells  are  seizures  or  transient  ischemic  attacks.  The  challenge  for  the  neurohospitalist  comes  when  the  clinical  picture  remains  unclear.  This  chapter  will  focus  on  spells  not  of  vascular,  epileptic,  or  psychogenic  origin.  In  particular,  there  will  be  an  emphasis  on  conditions  that  may  evade  the  standard  diagnostic  workup.  These  spells  may  occur  in  otherwise  healthy  patients  with  no  (known)  prior  neurological  history.  Patients  may  present  with  unexplained  collapse,  or  with  symptoms  that  are  not  immediately  suggestive  of  a  neurological  cause  such  as  nausea  and  malaise.  In  the  following  review  we  offer  diagnoses  to  also  think  of  when  the  standard  medical  workup  does  not  reveal  a  cause.