Practice 10-minute consultation

Collapse with loss of awareness

BMJ 2007; 334 doi: (Published 18 January 2007) Cite this as: BMJ 2007;334:153
  1. Dougall McCorry, research fellow in neurology1,
  2. Angela McCorry, general practitioner2
  1. 1Department of Neurosciences, The Walton Centre, Liverpool L9 7LJ
  2. 2Mather Avenue Surgery, Liverpool
  1. Correspondence to: D McCorry d.j.mccorry{at}

    A 24 year old woman attends your surgery after having collapsed and blacked out the day before at the department store where she works as a sales assistant. Colleagues told her that she had twitched and jerked.

    General points

    • Vasovagal syncope (simple faint) accounts for most collapses with loss of awareness in patients of good general health. Vasovagal syncope can sometimes be confused with other, more serious causes of collapse with loss of awareness, such as seizures and cardiac syncope.

    • Accounts of the incident from witnesses, as well as from the patient, are important in reaching a diagnosis. Phoning a witness is time well spent.

    • A collapse is a dramatic event, and terms such as “fitting” and “seizure” may be used. It is important to get a description rather than a label.

    • Do not rely too much on any one feature of the event. Instead develop a mind's eye …

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