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[[File:Annular-pancreas.jpg|center|500px|thumb|Case courtesy of Dr Morlie L Wang, Radiopaedia.org, rID: 13924]]
==Syncope==
===Syncope Definition===
[[Syncope]] is classified to three types:<ref name="pmid34260987">{{cite journal |vauthors=Surget E, Cheniti G, Ramirez FD, Leenhardt A, Nogami A, Gandjbakhch E, Extramiana F, Hidden-Lucet F, Pillois X, Benoist D, Krisai P, Nakatani Y, Nakashima T, Takagi T, Kamakura T, André C, Welte N, Chauvel R, Tixier R, Duchateau J, Pambrun T, Derval N, Jaïs P, Sacher F, Bernus O, Hocini M, Haïssaguerre M |title=Sex differences in the origin of Purkinje ectopy initiating idiopathic ventricular fibrillation |journal=Heart Rhythm |volume= |issue= |pages= |date=July 2021 |pmid=34260987 |doi=10.1016/j.hrthm.2021.07.007 |url=}}</ref><ref name="SurgetCheniti2021">{{cite journal|last1=Surget|first1=Elodie|last2=Cheniti|first2=Ghassen|last3=Ramirez|first3=F. Daniel|last4=Leenhardt|first4=Antoine|last5=Nogami|first5=Akihiko|last6=Gandjbakhch|first6=Estelle|last7=Extramiana|first7=Fabrice|last8=Hidden-Lucet|first8=Françoise|last9=Pillois|first9=Xavier|last10=Benoist|first10=David|last11=Krisai|first11=Philipp|last12=Nakatani|first12=Yosuke|last13=Nakashima|first13=Takashi|last14=Takagi|first14=Takamitsu|last15=Kamakura|first15=Tsukasa|last16=André|first16=Clémentine|last17=Welte|first17=Nicolas|last18=Chauvel|first18=Rémi|last19=Tixier|first19=Romain|last20=Duchateau|first20=Josselin|last21=Pambrun|first21=Thomas|last22=Derval|first22=Nicolas|last23=Jaïs|first23=Pierre|last24=Sacher|first24=Frédéric|last25=Bernus|first25=Olivier|last26=Hocini|first26=Mélèze|last27=Haïssaguerre|first27=Michel|title=Sex differences in the origin of Purkinje ectopy initiating idiopathic ventricular fibrillation|journal=Heart Rhythm|year=2021|issn=15475271|doi=10.1016/j.hrthm.2021.07.007}}</ref>
*[[Cardiac]]
*[[Neurogenic]]
*[[Vasovagal syncope|Vasovagal]]
<br />
{| class="wikitable"
|+
! colspan="5" |DDX of syncope
|-
|'''Condition'''
|History
|Physical
|Lab finfings
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|-
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<br />{{familytree/start |summary=Sample 1}}
{{familytree | | | | | | | | A01 |A01=Syncope}}
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | B01 | | | | | | | | B02 | | |B01=cardiac|B02=neurogenic}}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | C01 | | | | | | | | |!| |C01=C01}}
{{familytree | |,|-|^|.| | | | | | | | |!| }}
{{familytree | D01 | | D02 | | | | | | D03 |D01=D01|D02=D02|D03=D03}}
{{familytree | |!| | | | | | | | | |,|-|^|.| }}
{{familytree | E01 | | | | | | | E02 | | | E03 |E01=E01|E02=E02|E03=E03}}
{{familytree | | | | | | | | | | |!| | | | |!| }}
{{familytree | | | | | | | | | | F01 | | | F02 |F01=F01|F02=F02}}
{{familytree/end}}
[[File:Apple-core-sign-of-colonic-cancer-1.jpg|center|200px|thumb|Case courtesy of Dr Mohamed Mahmoud Elthokapy, Radiopaedia.org, rID: 91033]]
Aortic dissection is a life-threating disorder.
==Differential Diagnosis of Aortic Dissection==
===Differential Diagnosis of Aortic Dissection===
The ddx includes:
{| class="wikitable"
|+
! colspan="4" |Aortic dissection DDX
|-
!Disease
!Histrory
!Physical exam findings
!
|-
!
!
!
!
|-
|
|
|
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|-
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|}
<br />
==overview==
Syncope is classified into three types:
*Cardiac
*Vasovagal
*Neurogenic
{| class="wikitable"
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Differentiating diagnosis of Lymphoma
! colspan="5" style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Signs
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Diagnosis
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Additional Findings
|-
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Rash
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Diarrhea
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Abdominal pain
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Weight loss
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Painful lymphadenopathy
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Hepatosplenomegaly
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Arthritis
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Lab Findings
|-
| style="background:#DCDCDC;" align="center" + |Autoimmune lymphoproliferative syndrome
|
|
|
|
|
|
|
|
|
|
|-
| style="background:#DCDCDC;" align="center" + |[[Lymphoma]]
| +
|–
|–
| +
| +
|–
| +
|–
|Increase [[ESR]], increased [[LDH]]
|[[Night sweats]], constant fatigue
|-
| style="background:#DCDCDC;" align="center" + |[[Brucellosis]]
| +
| +
|–
| +
| +
| +
| +
| +
|[[Lymphocytosis|Relative lymphocytosis]]
|[[Night sweats]], often with characteristic smell, likened to wet hay
|-
| style="background:#DCDCDC;" align="center" + |[[Typhoid fever]]
| +
| +
|–
| +
|–
|–
| +
| +
|Decreased [[hemoglobin]]
|Incremental increase in temperature initially and than sustained [[fever]] as high as 40°C (104°F)
|-
| style="background:#DCDCDC;" align="center" + |[[Malaria]]
| +
|–
| +
| +
|–
|–
| +
| +
|Microcytosis,
elevated [[LDH]]
|"Tertian" fever: paroxysms occur every second day
|-
| style="background:#DCDCDC;" align="center" + |[[Tuberculosis]]
| +
| +
|–
| +
| +
| +
|–
| +
|Mild normocytic [[anemia]], [[hyponatremia]], and
[[hypercalcemia]]
|[[Night sweats]], constant fatigue
|-
| style="background:#DCDCDC;" align="center" + |[[Mumps]]
| +
|–
|–
|–
|–
| +
|–
|–
|[[Lymphocytosis|Relative lymphocytosis]], serum [[amylase]]<nowiki/>elevated
|[[Parotid gland|Parotid]]<nowiki/>swelling/tenderness
|-
| style="background:#DCDCDC;" align="center" + |[[Rheumatoid arthritis]]
|–
| +
|–
|–
|–
|–
|–
| +
|[[ESR]] and [[CRP]] elevated, positive [[rheumatoid factor]]
|Morning stiffness
|-
| style="background:#DCDCDC;" align="center" + |[[SLE]]
|–
| +
|–
| +
| +
|–
|–
| +
|[[ESR]] and [[CRP]] elevated, positive [[ANA]]
|[[Fatigue]]
|-
| style="background:#DCDCDC;" align="center" + |[[Human Immunodeficiency Virus|HIV]]
|–
|–
|–
| +
| +
| +
|–
| +
|Leukopenia
|Constant fatigue
|}
CNS lymphoma must be differentiated from other causes of seizures, headache, and fever in immunocompromised patients such as disseminated tuberculosis and disseminated aspergillosis.
{| class="wikitable"
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Differentiating signs and symptoms
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Differentiating tests
|-
| style="background:#DCDCDC;" align="center" + |Autoimmune lymphoproliferative syndrome
|
|
|-
| style="background:#DCDCDC;" align="center" + |[[Lymphoma|CNS lymphoma]]
|
*Patient is [[immunocompetent]]
*Focal symptoms indicative of a mass [[lesion]]
*[[Seizure]]
|
*Single solitary ring enhancing [[lesion]] on [[CT]] or [[MRI]]
|-
| style="background:#DCDCDC;" align="center" + |[[Disseminated tuberculosis]]
|
*Prior history of residence in an [[Endemic (epidemiology)|endemic]] area
*Chronic [[cough]], [[weight loss]], [[hemoptysis]]
|
*[[PCR]] of [[CSF]] for [[tuberculosis]]
*Mycobacterial culture of [[CSF]]
*[[Brain]] biopsy for [[acid-fast bacilli]] staining
*Culture and acid stain positive for [[acid-fast bacilli]]
*CXR shows [[Cavitation|cavitations]]
|-
| style="background:#DCDCDC;" align="center" + |[[Aspergillosis]]
|
*[[Pulmonary]] [[lesions]] in addition to [[CNS]] [[lesions]]
*Symptoms may include [[cough]], [[chest pain]], and [[hemoptysis]]
|
*[[CSF]] fungal culture, [[galactomannan]]
|-
| style="background:#DCDCDC;" align="center" + |[[Cryptococcosis]]
|
*Symptoms include [[cough]], [[chest pain]], and [[hemoptysis]]
|
*[[Cryptococcal infection|Cryptococcal]] [[antigen]] from [[CSF]] and [[serum]]
*[[CSF]] fungal culture
|-
| style="background:#DCDCDC;" align="center" + |[[Chagas disease]]
|
*History of residence in Central or  South America
*Acute infection is rarely symptomatic
*[[Encephalitis]] or focal [[brain]] [[lesions]]
*[[Myocarditis]]
*[[Chronic]] [[infections]] in [[immunocompromised]] patients develop into [[encephalitis]] with [[necrotic]] [[brain]] lesions causing a [[mass effect]]
|
*[[Trypanosoma cruzi]] in [[blood]], [[Tissue (biology)|tissue]], or [[CSF]], [[PCR]] of [[Tissue (biology)|tissue]] or [[body fluids]], and [[Serological testing|serologic tests]]
|-
| style="background:#DCDCDC;" align="center" + |[[Cytomegalovirus infection|CMV infection]]
|
*Most common [[CNS]] [[opportunistic infection]] in [[AIDS]] patients
*Presents with [[encephalitis]], [[retinitis]], progressive [[myelitis]], or [[polyradiculitis]]
*In [[disseminated disease]], it involves both the [[liver]] and kidneys
|
*[[Brain]] [[CT]]/[[MRI]]/[[biopsy]]: location of [[lesions]] is usually near the [[brain stem]] or periventricular areas
*[[PCR]] of [[CSF]] with detectable [[virus]] is diagnostic
*[[Brain biopsy]] with + [[staining]] for [[CMV]] or evidence of owl's eyes is also diagnostic, but it is rarely performed because of the location of [[brain]] lesions
|-
| style="background:#DCDCDC;" align="center" + |[[HSV|HSV infection]]
|
*[[Seizures]], [[headache]], [[confusion]] and/or [[urinary retention]] can be seen in [[disseminated disease]], which usually affects only the [[immunocompromised]] or acute [[infections]]
*In [[pregnant]] women, it may be associated with concurrent [[genital]]/[[oral]] [[lesions]]; can be spread to the [[neonate]] during acute infection in the mother, or via [[viral shedding]] in the [[birth canal]]
*[[Neonatal]] [[Herpes simplex virus|HSV]] can range from localized [[Skin and soft-tissue infections|skin infections]] to [[encephalitis]], [[pneumonitis]], and [[disseminated disease]]
|
*[[Brain]] [[CT]]/[[MRI]]/[[biopsy]]: location of [[lesions]] is usually the [[medial]] [[temporal lobe]] or the [[Orbital cavity|orbital]] surface of the [[frontal lobe]].
*[[PCR]] of [[CSF]] with detectable [[virus]] is diagnostic
|-
| style="background:#DCDCDC;" align="center" + |[[Chickenpox|Varicella Zoster infection]]
|
*Multifocal involvement has subacute course, usually only in [[immunosuppressed]], with [[headache]], [[fever]], focal deficits, and [[seizures]].
*Unifocal involvement is more typically seen in [[immunocompetent]] hosts, occurring after [[contralateral]] [[cranial nerve]] [[herpes zoster]], with [[Altered mental status|mental status changes]], [[TIA|TIAs]], and [[stroke]]
*[[Disseminated disease|Disseminated]] [[varicella zoster virus]] can occur in adults during primary [[infection]], presenting with [[pneumonitis]] and/or [[hepatitis]]
*Disease is a [[Vasculitis|vasculopathy]] with [[hemorrhage]] and [[stroke]]
|
*[[PCR]] of [[CSF]] with detectable [[virus]] is diagnostic
|-
| style="background:#DCDCDC;" align="center" + |[[Brain abscess]]
|
*Associated with [[sinusitis]] (abutting the sinuses) or with [[bacteremia]]
*Signs and symptoms includes [[fever]] and [[necrotizing]] [[brain]] [[lesions]] with [[mass effect]]
|
*[[CSF]] culture or culture of [[brain abscess]]
|-
| style="background:#DCDCDC;" align="center" + |[[Progressive multifocal leukoencephalopathy]]
|
*Symptoms are often more insidious in onset and progress over months. Symptoms include progressive [[weakness]], poor [[coordination]], with gradual slowing of [[mental]] function. Only seen in the [[immunosuppressed]]. Rarely associated with [[fever]] or other systemic symptoms
|
*[[Polymerase chain reaction|PCR]] of [[CSF]] for [[JC virus]]
*[[Biopsy]] reveals [[white matter]] [[lesions]] and not well-circumscribed [[lesions]].
|}
[[File:Bilateral-hip-avascular-necrosis-6.jpg|center|300px|thumb|Case courtesy of Dr Bahman Rasuli, Radiopaedia.org, rID: 90579]]
==Classification==
[[Syncope]] is classified into three components:
*[[Cardiac]]
**[[Neurogenic]]
*[[Vasovagal syncope|Vasovagal]]
<br />
{| class="wikitable"
|+
! colspan="4" |Classification of Syncope
|-
|'''Type'''
|Pathophysiology
|Treatment
|Additional information
|-
|
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|-
|
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|}
<br />{{familytree/start |summary=Sample 1}}
{{familytree | | | | | | | | A01 |A01=syncope}}
{{familytree | | | | |,|-|-|-|^|-|-|-|-|.| | | }}
{{familytree | | | B01 | | | | | | | | B02 | | |B01=cardiac|B02=neurogenic}}
{{familytree | | | |!| | | | | | | | | |!| }}
{{familytree | | | C01 | | | | | | | | |!| |C01=C01}}
{{familytree | |,|-|^|.| | | | | | | | |!| }}
{{familytree | D01 | | D02 | | | | | | D03 |D01=D01|D02=D02|D03=D03}}
{{familytree | |!| | | | | | | | | |,|-|^|.| }}
{{familytree | E01 | | | | | | | E02 | | | E03 |E01=E01|E02=E02|E03=E03}}
{{familytree | | | | | | | | | | |!| | | | |!| }}
{{familytree | | | | | | | | | | F01 | | | F02 |F01=F01|F02=F02}}
{{familytree/end}}
[[File:Fl000816-300x300.jpg|center|200px|thumb|wikimedia commons|link=Special:FilePath/Fl000816-300x300.jpg]]
{| class="wikitable"
|+
!disease
! colspan="4" |
|-
|
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|-
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|-
|
|
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|}
Syncope is classified into three types.
[[File:Sheehan.jpg|center|200px|thumb|Wikimedia commons]]
{| class="wikitable"
|+
! colspan="4" |Syncope classification
|-
|Cardia
|
|
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|-
|
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|-
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|
|}
==Syncope==
==Syncope is classified to three types:==
[[Syncope]] is classified into three types:
[[Syncope]] is classified into three types:
 
* [[Cardiac]]
 
* [[Neurogenic]]
 
* [[Vasovagal syncope|vasovagal]]
__NOTOC__
 
{{CMG}} {{AE}} {{Sahar}}
 
 
 
{{familytree/start}}<nowiki>{{familytree | | | | | | | | | A01 | | | | | |A01=Syncope}}
{{familytree | | | | | | | | | |!| | | | | | | | }}
{{familytree | | | | | | | | | B01 | | | | | |B01=B01}}
{{familytree | | |,|-|-|-|-|-|-|+|-|-|-|-|-|-|.| }}
{{familytree | | C01 | | | | | C03 | | | | |C02|C01=C01|C02=C02|C03=C03}}
{{familytree | | |!| | | | | | | | | | | | | |!| }}
{{familytree | | D01 | | | | | | | | | | | |D02|D01=D01'<br>D01''|D02=D02'<br>D02''}}
{{familytree | | |!| | | | | | | | | |,|-|-|-|+|-|-|-|-|.|}}
{{familytree | | E01 | | | | | | | | E02 | | E03 | | | E04 |E01=E01|E02=E02|E03=E03|E04=E04}}
{{familytree | | | | | | | | | | | | |!| | | |!| | | | |!| | }}
{{familytree | | | | | | | | | | | | F01 | | F02 | | | F03 |F01=F01|F02=F02|F03=F03}}
{{familytree/end}}
 
[[File:1196px-Rtbl400.gif|200px|center|Source:Wikimedia commons]]
 
 
==Syncope classifications:==
 
*Orthostatic:
 
*Cardiac
*Neurolgoic
 
<br />
{| class="wikitable"
|+
! colspan="5" |Syncope ddx
|-
|Clinical manifestations
|
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|-
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|-
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|}
<br />
<references />

Latest revision as of 00:32, 12 August 2021

Syncope is classified into three types:

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