Version May 2024
| Clinical features | Duration | Recall of the event | Diagnostic tools | |
| Focal seizure | Initial symptoms depend on location in brain; motor and visual symptoms usually "positive" (eg, shaking, jerking, flashing lights, or visual distortion); may have anatomic "march" over seconds; some progress rapidly to GTC | Usually <2 minutes; can be difficult to distinguish ictal from postictal phase | Variable depending on whether consciousness is impaired | EEG may show interictal spikes (poor sensitivity); ambulatory EEG if episodes are frequent enough; MRI may show structural lesion |
| Generalized seizure | Sudden alteration or loss of consciousness without warning; some have myoclonic jerks or staring; tongue-biting and urinary incontinence may occur (for GTC) | <5 minutes (for GTC); <1 minute for absence | Complete amnesia; patient may recall initial focal symptoms | EEG may show generalized spike-and-wave characteristic of specific syndrome; MRI usually normal for generalized epilepsy syndromes, may show structural lesion if focal onset |
| Psychogenic nonepileptic seizure | Fluctuating, asynchronous motor activity, often with eye closure, side-to-side head or body movements, pelvic thrusting; most occur in front of a witness; fully or partially alert despite bilateral motor activity; tongue-biting is rare | Rarely <1 minute; often prolonged (>30 minutes) | Variable | Video-EEG monitoring |
| Syncope | Transient loss of consciousness resulting in loss of postural tone; prodrome of lightheadedness, warm or cold feeing, sweating, palpitations, pallor; myoclonic jerks or tonic posturing may occur, especially if patient is kept upright; no or minimal post-event confusion | 1 to 2 minutes | Patient can recall prodromal symptoms, if present; lack of warning may suggest cardiac source | ECG; echocardiography if structural cardiac disease is suspected; ambulatory ECG monitoring if arrhythmia is suspected; orthostatic blood pressure measurements |
| Transient ischemic attack (TIA) | Rapid loss of neurologic function due to interrupted blood flow; symptoms depend on vascular territory but are typically "negative" (eg, weakness, numbness, aphasia, visual loss); intensity is usually maximal at onset; consciousness usually preserved | Several minutes to a few hours | Usually complete unless language areas involved | MRI/MRA, CTA, vascular risk factors |
| Migraine aura | Positive and/or negative neurologic symptoms, most often visual and sensory, evolving gradually over ≥5 minutes (slower onset than TIA or focal seizure); slow spread of positive followed by negative symptoms, if present, is very characteristic; usually followed by headache | Up to 1 hour | Complete | Personal or family history of migraine |
| Panic attack | Palpitations, dyspnea, chest pain, lightheadedness, sense of impending doom; associated hyperventilation may result in perioral and distal limb paresthesias | Minutes to hours | Complete | History of anxiety or depressive symptoms, triggering events or stressors |
| Transient global amnesia | Prominent anterograde amnesia (inability to form new memories) and variable retrograde amnesia; patient is disoriented in time, asking repetitive questions; other cognitive and motor functions spared; rare in adults younger than 50 years | 1 to 10 hours (mean 6 hours) | Complete amnesia for the main episode; retrograde amnesia resolves within 24 hours | Clinical diagnosis; negative MRI and toxicology screens |
آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
