Syncope: Causes and Concerns in Elderly Patients

Conscious syncope

Hello doctor, my mother is 65 years old and has a history of low blood pressure, chronic moderate insomnia, autonomic nervous system dysfunction, and headaches.
She often relies on sleeping pills to fall asleep and takes acetaminophen to alleviate her headaches.
Last night, while I was sleeping, I suddenly heard a loud, painful moaning sound outside my door, like a continuous "uh-oh" sound.
When I opened the door, I found my mother lying on the table at a 90-degree angle, with her feet on the ground, her body tense and rigid, and her eyes half-closed with upward gaze.
I repeatedly tapped her shoulder and called her name, but she remained unresponsive, continuing to emit the painful "uh-oh" sound.
It wasn't until my father helped by pushing on her chest that she slowly relaxed and regained consciousness.
After regaining consciousness, she was completely limp and weak, but after resting for a while, she regained some strength.
When I asked her what had happened, she said she got up to take her medication and suddenly felt dizzy.
When I probed further, she was reluctant to discuss it and seemed unsure if she remembered.
In the morning, I asked my father about the situation, and he suggested it might have been caused by the medication leading to a state of confusion, but my mother has never experienced anything like this before.
I am very worried and unsure about the cause of this incident and what symptoms I should be looking for.

Mia, 30~39 year old female. Ask Date: 2023/03/27

Dr. Wu Mukhan reply Neurology

Hello, your mother's symptoms may possibly be caused by seizures or syncope related to cardiac issues.
It is advisable to arrange for further examinations at a hospital's neurology department.

Reply Date: 2023/03/27

More Info

Syncope, or fainting, is a sudden and temporary loss of consciousness, often due to a lack of blood flow to the brain. In elderly patients, syncope can be particularly concerning due to the potential for underlying health issues and the risk of falls and injuries. In the case of your mother, who is 65 years old and has a history of low blood pressure, insomnia, autonomic nervous system dysfunction, and headaches, there are several factors that could contribute to her recent episode.

Firstly, low blood pressure (hypotension) can lead to inadequate blood flow to the brain, especially when standing up quickly or after prolonged periods of sitting or lying down. This can result in dizziness, lightheadedness, and syncope. Additionally, medications such as sedatives or pain relievers can further lower blood pressure or cause sedation, increasing the risk of fainting. Your mother’s reliance on sleeping pills and pain medications could have compounded her symptoms, especially if she took them close to the time of her episode.

The episode you described, where your mother was found lying on the floor, stiff and unresponsive, suggests a possible seizure or a severe vasovagal response, which is a common cause of syncope. The "oh" sounds she was making could indicate a postictal state, which is the confusion and disorientation that can occur after a seizure. However, it is crucial to differentiate between a seizure and syncope, as the management and implications of each condition differ significantly.

Given your mother's symptoms and the episode she experienced, it is essential to seek medical attention promptly. Here are some steps you can take:
1. Consult a Healthcare Provider: Schedule an appointment with her primary care physician or a neurologist. They can perform a thorough evaluation, including a physical examination, a review of her medication, and possibly order tests such as blood tests, an electrocardiogram (ECG), or an EEG (electroencephalogram) to assess for seizure activity.

2. Medication Review: Discuss her current medications with her doctor. It may be necessary to adjust dosages or change medications to minimize side effects like dizziness or sedation.

3. Monitor Blood Pressure: Regularly check her blood pressure, especially when she changes positions (e.g., standing up from sitting or lying down). This can help identify patterns of hypotension that may contribute to her symptoms.

4. Lifestyle Modifications: Encourage her to stay hydrated, avoid sudden changes in position, and consider dietary adjustments that may help manage her blood pressure.
5. Emergency Plan: Develop a plan for what to do if she experiences another episode. This may include having someone nearby when she takes her medications or ensuring she has a way to call for help if needed.

6. Follow-Up Care: Ensure that she has regular follow-ups with her healthcare provider to monitor her condition and adjust her treatment plan as necessary.

In summary, syncope in elderly patients can have various causes, including medication effects, low blood pressure, and potential neurological issues. Given your mother's complex medical history, it is vital to seek a comprehensive evaluation to determine the underlying cause of her episode and to develop an appropriate management plan. Early intervention can help prevent future episodes and ensure her safety and well-being.

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