Breath-holding attacks (children)
Serious disorders not to be missed
Cardiac arrhythmias/long QT syndrome
Atypical tonic--clonic seizures
Electrolyte disturbances (e.g. hypokalaemia)
Diabetes (hypoglycaemia, ketoacidosis)
Endocrine (Addison disease, hypothyroidism)
Spinal dysfunction (cervical spondylosis)
Is the patient trying to tell me something?
Highly likely. Psychogenic-pseudo-seizures and ‘communication’ disorders quite significant.
Fundamental to diagnosis. A reliable eyewitness account of the ‘turn’ is invaluable. Determine what the patient means by ‘funny turn’. Evaluate the mental, personal and social factors. Assess three components: lead-up to the episode, description of the episode and post-episode events. Consider onset, precipitation factors and associated symptoms; also drug history and past history, especially substance abuse.
Evaluate mental state, cerebrovascular/cardiovascular status, cervical spine
Look for evidence of anaemia, alcohol abuse and infection
The commonest cause of ‘funny turns’ is lightheadedness, often related to psychogenic factors such as anxiety, panic and hyperventilation. Patients usually call this dizziness.
Migraine is a great mimic and can cause confusion in diagnosis.
The more bizarre the description of a ‘funny turn’ the more likely a functional problem is the cause.