Transient Impairment of Consciousness

Diagnosis/Definition

Credible history of impairment or loss of consciousness with complete return to mental status baseline in 24 hours or less.

Initial Diagnosis and Management

• History and physical examination, including neurologic, cardiologic and a supervised period of at least 3 minutes of hyperventilation.
• Electrocardiogram, serum glucose, electroencephalogram (EEG), thyroid screen and holter if clinically indicated.
• Reassurance, treatment of underlying glucose abnormality or thyroid disease.

Ongoing Management and Objectives

Depends upon underlying cause (neurologic, cardiac, metabolic, psychogenic).

Indications for Specialty Care Referral

History suspicious for seizure disorder.

Abnormal neurological exam in which case head imaging should be added to pre-referral test list.

Abnormal EEG.

Criteria for Return to Primary Care

Neurology opinion that cause is not within the nervous system.

Underlying cause treated and stabilized, manageable by primary care with occasional or prn neurologic input.