STARS Patient Information
The Blackouts Checklist was prepared under the guidance of STARS’ expert Medical Advisory Committee. Its principal aim is to help you and your doctor reach the correct diagnosis for any unexplained loss of consciousness (blackout).
The Checklist gives you information and advice on the major reasons for experiencing a blackout, helps you prepare for a doctor’s appointment, and provides information on what to expect if you have to attend a hospital appointment.
CHECKLIST: What do you need to know?
A blackout is a temporary loss of consciousness
If someone loses consciousness for a few seconds or minutes, they are often said to have had a blackout.
Every patient presenting with an unexplained blackout should be given a 12-lead ECG (heart rhythm check)
It is important that the ECG is passed as normal.
Most unexplained blackouts are caused by syncope
Many people, including doctors, assume that blackouts are due to epileptic seizures, but much more commonly they are due to syncope (pronounced sin-co-pee) – a type of blackout which is caused by a problem in the regulation of blood pressure or sometimes with the heart. Up to 40% of the population will lose consciousness at some point in their life due to syncope. Syncope can affect all age groups but the causes vary with age, and in older adults multiple causes often exist.
Many syncopal attacks only require reassurance from your GP
Many syncopal attacks require only explanation and reassurance from a GP or trained nurse regarding the likely absence of anything being seriously wrong. Consultation with a specialist will be necessary, though, if the cause of the syncope remains uncertain or if there are particularly concerning symptoms or there is a family history of a heart condition.
There are three major reasons for why people may experience a blackout(s):
– Syncope: a sudden lack of blood supply to the brain. Syncope is caused by a problem in the
regulation of blood pressure or by a problem with
– Epilepsy: an electrical ‘short-circuiting’ in the brain. Epileptic attacks are usually called seizures.
Diagnosis of epilepsy is made by a neurologist.
– Psychogenic blackouts: resulting from stress or anxiety. Psychogenic blackouts occur most often in young adults. They may be very difficult to diagnose. 'Psychogenic' does not mean that people are 'putting it on'. However there is often underlying stress due to extreme pressure at school or work. In exceptional cases it may be that some people have experienced ill treatment or abuse in childhood.
Misdiagnosis is common but avoidable:
- Many syncopal attacks are mistaken for epilepsy.
- However epilepsy only affects slightly less than 1% of the population.
- UK research has shown that approximately 30% of adults and up to 40% of children diagnosed with epilepsy in the UK do not have the condition.
- Many elements of a syncopal attack, such as random jerking of limbs, are similar to those experienced during an epileptic seizure.
- It can be difficult to tell the causes of the blackout apart.
Syncope causes falls:
- Syncope causes a significant number of falls in older adults, particularly where the falls are sudden and not obviously the result of a trip or slip.
- Many older adults will only recall a fall and will not realise they have blacked out.
- Greater awareness of syncope as a cause of falls is key to effective treatment and prevention of recurring falls.