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Dr. Andrew Rynne

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What causes sudden unconsciousness and temporary unresponsiveness

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Dr. Olsi Taka

Neurologist

Practicing since :2004

Answered : 3599 Questions

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Posted on Mon, 19 Oct 2015 in Hypertension and Heart Disease
Question: I had a recent hospitalization after passing out in Walmart followed by 2 hour period of unresponsiveness. I had EKG, EEG, CT scan, MRI all normal. Prior to incident, I had been experiencing frequent intense hot flashes (I am a 55 yr old woman), and am wondering if this incident could have been in response. Strangely, I have not had a hot flash since the incident. I am dismayed that I have been put on anti-seizure medication and have been told I am not allowed to drive for 6 months, even though there is no clear evidence of seizure. My PCP wants to persue cardiology w/echocardiogram and holster. I feel like no one is listening to me. Any suggestions for getting me out of this jam?
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Answered by Dr. Olsi Taka 1 hour later
Brief Answer:
Read below

Detailed Answer:
I read your question carefully and I understand your concern.

I understand you are frustrated but you should know that it is at times very difficult to differentiate, even for the best of doctors, whether an episode with loss of consciousness is due to a cardiac cause or a seizure (or also a metabolic cause). It would have been useful to have a more detailed description of the episode, of what preceded it, what did the witnesses describe (if there were any), how much it lasted (2 hours of complete loss of consciousness, or perhaps losing consciousness for some minutes, followed with confusion for 2 hours) etc.
Personally if this was only a first isolated episode, with a normal EEG and MRI, I wouldn't have started antiepileptics even if the description was compatible with seizures. That doesn't mean I exclude them (an EEG evidences changes outside the seizure episode only in half the patients, and MRI is done only to search for causes like stroke, tumor etc), but I would wait for a second seizure before making the diagnosis of epilepsy and starting treatment which is taken for such a long time. If the episode is doubtful to be a seizure of course even more caution is needed before initiating treatment.

Since the rest were normal I do agree with the PCP recommendation, a Holter and an echocardiogram are advisable (although if you were unconscious at the ER some change on cardiac exam should have been noticed there).

The hot flashes history goes in favour of a syncope, meaning a transitory lack of blood supply (reinforcing a cardiac cause).

I remain at your disposal for further questions
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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