Fits, faints and funny turns

Fits, faints and funny turns represent a common reason for presentation – either to the general practitioner or to the emergency department. In many cases, the consultation is dissatisfying for the doctor and the patient, as such patients frequently present a diagnostic dilemma for the clinician. Frequently, the key to a satisfactory evaluation is a structured approach, premised on a clear and comprehensive history focused on prior comorbidities and the episode – its context, precipitating factors, prior situational factors, onset and evolution, and events occurring afterwards. A detailed and carefully elicited medical history allows the clinician to confirm the diagnosis, delineate the underlying mechanism, and identify features that may suggest high risk of recurrence, injury or death. This issue of CME includes a series of articles on approaches to common causes of fits, faints and funny turns in adults (Table 1). The four articles emphasise the underlying mechanisms for such episodes and provide the busy clinician with a sound and simplified approach to the clinical evaluation and management. In the first article, by Ntusi et al., [1] the pathophysiology of and clinical approach to syncope are reviewed. The classification, which is based on the underlying pathophysiological mechanism causing the event, includes cardiac, orthostatic and reflex (neurally mediated) mechanisms. The prognosis of syncope relates to: (i) the risk of death and life-threatening events; and (ii) the risk of recurrence of the syncope and physical injury. The history is key to the assessment of the patient with syncope. The routine use of a broad panel of laboratory tests is not recommended and tests should only be requested if clinically indicated; however, an ECG should be performed in all patients. The goals of management are to prolong survival, limit physical injuries and prevent recurrences. Patients with life-threatening causes of syncope should be managed urgently and appropriately. In the second article, Lee-Pan and Tucker [2] provide a comprehensive review of epilepsy in adults and introduce the reader to an updated classification of epilepsy. A Generalised seizure indicates a disorder in which the entire cortex instantly becomes epileptiform in nature, and may be classified as Absence or Generalised Tonic-Clonic Seizure (GTCS). Focal seizures may occur with retained or altered awareness, or evolve secondarily into a GTCS. While not always easy, it is fundamentally important to differentiate Generalised from Focal seizures, as the two have a different aetiology and pathophysiology, Table 1. Common causes of fits, …