Syncope, Collapse, Falls and TIA
Unexplained loss of consciousness, falls, and transient neurological symptoms are common and often distressing. They span cardiac, neurological, and metabolic causes, and a thorough assessment from a general physician is often the most efficient route to a diagnosis. Dr Rory McQuillan provides specialist evaluation drawing on his dual training as both a nephrologist and a consultant in general internal medicine.
Understanding the symptoms
Syncope is a sudden, brief loss of consciousness with full and rapid recovery. Collapse can mean a range of events including syncope, falls without loss of consciousness, and seizures. A transient ischaemic attack (TIA) is a brief neurological deficit that resolves within 24 hours and is a warning sign for stroke. Falls in older adults often have multiple contributing causes.
Common causes
- Vasovagal syncope (the most common cause of fainting)
- Orthostatic hypotension (low blood pressure on standing)
- Cardiac arrhythmias (irregular heart rhythms)
- Carotid sinus hypersensitivity
- TIA or stroke
- Seizures
- Hypoglycaemia (low blood sugar)
- Electrolyte disturbances
- Medication side effects
Specialist assessment
A structured assessment includes:
- Detailed history of the events and any warning symptoms
- Review of medications and medical history
- Examination including lying and standing blood pressure
- ECG and where indicated 24-hour or longer Holter monitoring
- Echocardiogram in selected cases
- Tilt-table testing where vasovagal or orthostatic syncope is suspected
- Carotid Doppler ultrasound for suspected TIA
- Blood tests including electrolytes, glucose, and full blood count
- Neurological imaging where indicated
Treatment and prevention
Treatment depends on the cause. For vasovagal syncope it may involve avoidance of triggers, hydration, and physical counter-pressure manoeuvres. For orthostatic hypotension it includes medication review and lifestyle measures. For cardiac causes it may involve antiarrhythmic medication or referral for pacing. For TIA it involves urgent antiplatelet therapy, blood pressure control, statins, and addressing risk factors.
Appointments
Appointments are arranged through GP referral. Urgent appointments are available for suspected TIA.
Frequently Asked Questions
A single vasovagal faint with clear triggers may not need extensive investigation. Repeated episodes, episodes without warning, or episodes during exertion warrant specialist assessment.
A TIA causes the same symptoms as a stroke but resolves within 24 hours (usually much sooner). It is a major warning sign and needs urgent assessment.
Falls usually have multiple causes including balance problems, medication side effects, blood pressure, vision, and the home environment. A structured assessment identifies what can be modified.
Tilt-table testing is helpful in some patients with unexplained syncope, particularly when vasovagal or orthostatic causes are suspected and clinical history is inconclusive.
Have a Question?
If you’d like more information about Dr. McQuillan’s services or need assistance from the practice team, please get in touch below.
Please note: Appointments are arranged via GP referral.