What should you know about neurological causes of syncope?

Syncope usually reflects a brief reduction in brain blood flow, with relatively quick recovery. Seizures and other neurological events can look similar but may involve prolonged confusion, a bitten tongue, unusual movements or loss of bladder control. These clues are not enough to diagnose the cause at home.

A clinician may ask a witness to describe the colour, posture, movements, breathing and recovery. They may check blood pressure, heart rhythm, medicines and blood tests. Dehydration, low blood sugar, anaemia and atrial fibrillation can also cause collapse or mimic part of the story.

Protect the person from nearby hazards, place them on their side if they are unconscious but breathing, and monitor breathing. Do not restrain jerking movements or put anything in the mouth. Note the sequence of symptoms and recovery, and arrange medical review before driving or returning to risky activities.

Call emergency services for continuing unresponsiveness, abnormal breathing, a first seizure-like event, a new one-sided weakness, speech trouble, severe headache, chest pain, serious injury or repeated episodes without recovery. Do not wait for a routine appointment when confusion persists after the collapse.

Does the witness account fit syncope, seizure or another event? Which tests are appropriate? Could my medicines, hydration, blood count, glucose or heart rhythm contribute? What restrictions should I follow until the cause is clearer?