Neurological Other neurological differentials = neuropathy (e.g. MS), intracranial haemorrhages (extradural, subarachnoid, subdural), raised intracranial pressure Cardiovascular Other cardiovascular differentials Structural (e.g. hypertrophic obstructive cardiomyopathy, arrhythmogenic right ventricular dysplasia)Massive PEVertebrobasilar insufficiency (vertigo precipitated by head extension in elderly patients with cervical osteoarthritis)Subclavian steal syndrome (proximal subclavian artery stenosis causes retrograde flow in one of the vertebral arteries as they become involved in a collateral circuit to bypass the obstruction) Reflex Other reflex differentials Carotid sinus hypersensitivity (precipitated by head turning/shaving – diagnosed by carotid sinus massage** → ≥3 second pauses) Other Other differentials = postural instability, polypharmacy, ectopic pregnancy, ruptured AAA, delirium, vertigo, anaemia, hypoglycaemia, hypercapnic acidosis, sepsis, eyesight problems, arthritis, leg weakness, anxiety, factitious blackouts, choking, heat syncope, multifactorial Test your knowledge What are the red flag symptoms for cardiac syncope? Arrhythmogenic: No warningPalpitations/feel strange beforeSyncope when supineChest painNew/unexplained breathlessnessCardiac history/severe LVFFamily history of sudden death Structural (e.g. HOCUM, valve disease): Syncope on exertionCardiac history/lesionFamily history of sudden death In a patient whom you suspect has cardiac syncope, what would you look for specifically in the ECG? QT: Long QT or short QT intervalRhythm strip: tachy/bradycardias, pausesPR: heartblock; Delta waves/short PR (WPW)QRS: pathological Q waves (cardiomyopathies); bundle branch block/bifascicular/trifascicular block; ventricular hypertrophy (HOCUM, AS)ST: Brugada pattern (Brugada syndrome); Epsilon waves (AVRD)T: T wave inversion (right leads = AVRD, PE) What are the different types of generalised seizure? Absence: brief staring episodeMyoclonic: extremely brief muscle contractions that look like jerky movementsTonic: tense contraction of musclesClonic: rhythmic muscle contractionsTonic-clonic: initial muscle contraction (tonic phase) followed by rhythmic muscle contractions (clonic phase)Atonic: loss of muscle tone Try some OSCE stations Status EpilepticusTransient ischemic attackStrokeFind lots more here!