1/Patient admitted to your service with “syncope” after losing consciousness. You notice this on the right side of his tongue.

What caused him to lose consciousness?

(Posted with permission)

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2/You will likely see a lot of people billed to you as “syncope”. I would counsel you to take a step back and frame them as loss of consciousness.

Recall that to have true syncope one needs loss of consciousness + postural tone due to CNS perfusion.

3/Before landing on true syncope, you need to rule out mimics such as seizure and gluc that don’t mess with the plumbing.

I love syncope/LOC because the diagnosis is almost exclusively in history. However every once in a while exam gives it away

4/In a patient who loses consciousness, finding of lateral tongue fighting has been found to be BANANAS specific for:

5/If you said seizure, you are correct! A small study documented the incidence of lat tongue lacs in pts admitted for EEG monitoring and used a retrospec syncope cohort for comparison

Lateral tongue biting ~100% spec, 24% sens for seizure https://pubmed.ncbi.nlm.nih.gov/7487261/ 

6/Key takeaways:

Start with LOC before calling it syncope. Check out @StephVSherman and @CPSolvers schema!

Look in pt’s mouths who lose consciousness. It’s free, takes 2 seconds and may massively move the needle diagnostically.

Thanks for tuning in!

@mghmedres