Fainting is defined as a short-term loss of consciousness. It has many different causes. First of all, consciousness is a cognitive function that occurs as a result of the holistic functioning of the brain regions in connection with each other. Consciousness expresses the person's awareness of himself and his environment. It is necessary for any physical or structural damage in the brain. Any change or change in other organs of the body can cause a change in consciousness and ultimately a loss of consciousness. We have emphasized that there may be more than one cause of loss of consciousness or change of consciousness and that changes in more than one system can lead to a change in consciousness. Among these, neurological ones are caused by the brain itself being affected or originating from the brain. One of the most common causes of neurological changes in consciousness is epileptic seizures, commonly known as epilepsy. However, not all epileptic seizures have to result in fainting. Some epileptic seizures proceed as seizures in which the person is conscious. However, when looking at epileptic seizures that result in fainting, there are two conditions that should be taken into consideration in the differential diagnosis. One of these is the change in the blood supply to the brain due to a problem in the heart. that is, a change in the direction of decrease and then a change in consciousness, that is, loss of consciousness, is observed in the person. Another situation is a change in consciousness that develops due to psychological reasons. This is not a real change of consciousness or loss of consciousness. However, the loss of consciousness and cardiac rhythm disorder that we see especially in epilepsy patients is caused by It is very important because it causes confusion with loss of consciousness and causes wrong diagnosis and wrong treatment in patients.
We have mentioned that neurologically-related loss of consciousness may accompany epileptic seizures, and that in the differential diagnosis of these, the change in the blood supply to the brain due to heart rhythm disorders and fainting due to changes should be taken into consideration. Another important reason is due to psychological reasons. g progressive changes in consciousness and ultimately loss of consciousness.
When we look at their frequency, psychologically-related fainting and changes in consciousness and cardiac-related changes in consciousness and fainting are much more common than loss of consciousness accompanied by neurological epilepsy seizures. Therefore, the person suffers from a change in consciousness or loss of consciousness. /p>
The first thing to consider when applying is to question the existence of these two causes of fainting.
We need to find answers to the questions of how we should behave in a patient who complains of fainting, what tests we should request, and what is the right treatment approach after the correct diagnosis is made. However, first of all, it should be questioned whether this is fainting or not. As we said when defining consciousness, consciousness is the person's own. It is considered as awareness of the patient and the environment. Therefore, the presence of a change in consciousness or loss of consciousness should lead to a change in this awareness. This should be taken into account when questioning the presence of a real change in consciousness or a real loss of consciousness in patients. Then, the necessary examinations should be taken from the patient in terms of three basic reasons that may lead to a change in consciousness. However, the tests to be requested may vary depending on the person's other concomitant diseases, cardiac causes, psychological stressors, and neurological comorbidities.
However, among these causes of fainting, examinations should be requested in terms of reversible, treatable, or at least stoppable diseases, that is, from more serious diseases to less important diseases, such as psychologically-induced fainting. And the examinations should be ordered in this way. For this reason, it is useful to consider the primary cause as loss of consciousness originating neurologically from the brain. A brain imaging should be requested first in such patients. It should be evaluated whether there is a structural lesion that will cause a change in consciousness. Fainting is seen in cardiac rhythm disorders. If it is present, cardiac causes should be examined. Electrolyte changes in the person's blood or the presence of an infection in the blood, that is, any biochemical change in the laboratory data in the blood, will affect the intercellular communication in the brain and cause the disruption of the harmonious functioning of all brain cells that form consciousness. Therefore, routine blood tests are used to reveal cardiac rhythm. After electrocardiography, that is, ECG, a test called Electroecephalography should be requested to image the brain and evaluate the person's brain activity. The test we call Electroencephalography, in short, or EEG, as it is commonly known, can be used not only in patients with epileptic seizures, but also in disorders related to another organ in the body, to evaluate whether the brain is affected.
In cases where no disorder is detected in these routine examinations required from patients in the first step, the patient's social situation and the presence or intensity of psychological stressors should be questioned.
If the presence of any condition that may cause fainting is not detected, the person should be followed up as a priority and, if necessary, routine electroencephalography, that is, electroencephalography performed during short-term wakefulness, as well as longer-term monitoring should be performed. The most important examination of the patient is the change of consciousness, that is, the patient's It is the EEG recording obtained in the event of a change in consciousness or loss of consciousness that it describes. If the person has clinical complaints during this long-term EEG recording and if a disorder indicating epilepsy is detected in the EEG, the person will be diagnosed with epilepsy as the cause of the change of consciousness or fainting. However, It may not be easy to achieve this in most patients. We should point out that epileptic discharges are not detected during EEG recording in any of the fainting cases of cardiac or psychological origin. There is only one condition in which epileptic discharges are obtained, and that is epilepsy diseases, which are epileptic seizures.
If cardiac and psychological reasons are considered and diagnosed as the cause of fainting, the person However, patients diagnosed with fainting of psychological origin should be followed up for epileptic seizures in the long term and EEG recordings should be obtained intermittently. Because most diseases of psychological origin, that is, fainting, epileptic seizures of psychological origin, movement disorders of psychological origin, or psychogenic psychogenic origin of psychological origin. In most neurological diseases of psychological origin, such as dementia, when patients are followed up in the later stages, findings indicating a real physiological disorder can be obtained. Because EEG recordings are physiological records and can record instantly.