By M.J.G. Harrison (Eds.)
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Extra info for Contemporary Neurology
1. Cardiac causes of funny turns Cardiac arrhythmias heart block sick sinus syndrome paroxysmal tachycardia Fainting Carotid sinus syncope Funny turns in patients with pacemakers external interference myopotential inhibition loss of atrial synchrony Funny turns that do not involve arrhythmias impaired atrial filling atrioventricular valve obstruction impaired ventricular function ventricular outflow obstruction Drugs drugs causing conduction disturbances drugs causing arrhythmias vasodilators Funny turns—cardiac 29 Although funny turns are by definition self-limiting it is important to make as accurate a diagnosis as possible, partly for the patient's peace of mind and partly because funny turns may occasionally be the presenting feature of a life-threatening condition.
Postictally there is often a transient hemiparesis (Todd's paralysis). Sensory attacks may show a similar distribution anatomically with complaints of tingling, altered sensation, "shocks", and even pain and distortions of body image. Again there may be no loss of consciousness. Such sensory attacks may be difficult to differentiate from transient ischaemic episodes. Transient sensory symptoms may also appear in patients with multiple sclerosis. These symptoms are commonly associated with brief episodes of speech disturbance and unsteadiness, sometimes accompanied by complaints of a "woolly head" or dizziness (Espir et al, 1966).
In younger patients on the other hand sinus bradycardia, sinus pauses, and transient Wenckebach atrioventricular block are well documented in fit, athletic, and asymptomatic individuals, possibly as a consequence of increased vagal tone (Meytes et al, 1975; Brodsky et al, 1977), and seem to be particularly common in children (Scott et al, 1980; Southall et al, 1981). While these observations should lead to extreme caution in making diagnoses from ambulatory recordings in young people, symptomatic sick sinus syndrome is nevertheless well documented in both children (Scott et al, 1976) and young adults (Mackintosh, 1981).
Contemporary Neurology by M.J.G. Harrison (Eds.)