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University Education

University Education

Syncope is classified yo three categories:

 
 
 
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Box 2 in Row 2
 
 
 
 
 
 
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Case courtesy of Dr Subhan Iqbal, Radiopaedia.org, rID: 76341


DDx of syncope




Patient Past Medical History Later presentation GCS Lab. Findings Specific Tests Imaging studies
CBC CSF MRI/CT scan
1. 84-year old man in France presented with dyspnea and cough[1] Diabetes Mellitus,

Hypertension,

Atrial fibrillation,

Peripheral Arterial Disease,

Coronary Heart Disease

Worsening headache, Sore throat. (Day 5)

Impaired consciousness and transient generalized seizure, (Day 9)

E4V1M1 WBCs and neutrophils
lymphocytes

CRP

Clear and colorless fluid,

Pressure=320 mmH2O,

Cell count was 12/μL–10

mononuclear and 2 polymorphonuclear cells

RT-PCR for SARS-CoV-2 was positive in nasopharyngeal swab Brain MRI:

Hyperintensity in the right lateral ventricle's inferior horn along the wall,

pan-paranasal sinusitis.

2. 74-year old man in France presented with confusion and influenza-like illness[1] Flu like symptoms Headache, nausea, dizziness, and

drug-refractory seizures.

E4V5M6 NA NA RT-PCR and antibody tests positive Brain MRI: Hyperintensity in the left temporal lobe.

MR Spectroscopy: Decrease N-acetyl aspartate peak along with a marked elevated choline peak.

3. 31-year-old African American woman[2] SCD patient with dyspnea Paralysis and sedation (Day 13)

Comatose (Day 15) and death (Day 16)

E0V0M0 NA Pressure=30cmH2O

115 nucleated cell /ml

7374 erythrocytes

/ml

Protein> 200mg/dl

RT=PCR for SARS-CoV-2 was positive in nasopharyngeal swab Brain MRI: Nonenhancing cerebral edema and restricted diffusion in the right cerebral hemisphere with brain herniation.
  1. 1.0 1.1 Zayet, Souheil; Klopfenstein, Timothée; Kovẚcs, Róbert; Stancescu, Silviu; Hagenkötter, Beate (2020). "Acute Cerebral Stroke with Multiple Infarctions and COVID-19, France, 2020". Emerging Infectious Diseases. 26 (9). doi:10.3201/eid2609.201791. ISSN 1080-6040.
  2. Benameur K, Agarwal A, Auld SC, Butters MP, Webster AS, Ozturk T; et al. (2020). "Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020". Emerg Infect Dis. 26 (9). doi:10.3201/eid2609.202122. PMID 32487282 Check |pmid= value (help).