The principal differential diagnosis is between an epileptic fit and a syncopal attack, or fainting. Syncope is a sudden loss of consciousness due to temporary failure of the cerebral circulation. Syncope is distinguished from a seizure principally by the circumstances in which the event occurs. For example, syncope usually occurs whilst standing, under situations of severe stress,or in association with an arrhythmia.Sometimes a convulsion and urinary incontinence-loss of control of the bladder-occur even in a syncopal attack. Thus, neither of these is specific for an epileptic attack. The key is to establish the presence or absence of prodromal symptoms, or symptoms that occur immediately before the attack. Syncopal episodes are usually preceded by symptoms of dizziness and light-headedness. In epilepsy, people may get a warning, known as an aura, that an attack is going to happen.
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