FUNNY TURNS - Full extract 

Alf is a retired gardener who still mows a few lawns in the area. One evening his wife urgently phoned the surgery. She had found him slumped on the kitchen floor.  

When I arrived a few minutes later he was coming around but still rather pale and clammy. His blood pressure was very low as was his pulse rate, only 32 beats per minute. This was confirmed with an ECG. 

Within a few minutes he was as bright as a button and wondering what all the fuss was about. He had no recollection of feeling woozy or actually falling down. His blood pressure had returned to normal and his pulse rate had come up to 68 per minute. On closer questioning, his wife recalled that Alf had a similar black-out in his garage a month or so previously. It had lasted less than a minute and they thought there was no need to see the doctor about it. 

The history, clinical findings and ECG all indicated a heart block problem. I contacted the Casualty department at the local hospital and arranged for an ambulance. The following day he had a permanent pacemaker inserted. He was discharged home a couple of days later and has had no further episodes. 

Since the year dot people have been having funny turns . As a child I remember my grandmother being very concerned about her neighbour having a funny turn. It is an odd expression because the situation is anything but funny for the poor person who has one. 

A funny turn generally means a sudden, short-lived episode when someone becomes dizzy, wobbly on the feet, confused or perhaps blacks out altogether. These non-specific episodes can be caused by drops in blood pressure, stress, minor strokes, heart problems, migraine, certain types of epilepsy, and several other causes. Every case requires careful medical assessment. 

Working out the precise cause of a funny turn can be rather like a detective story. There are some definite clues in the history that might give us the answer.

Drop-attacks.  These are episodes when the person falls to the ground without warning, without so much as feeling woozy. These are always significant and may be due to abnormal heart rhythms or perhaps a mild stroke.

Associated neurological symptoms   like loss of power in a limb, confusion, or inability to express oneself. These features suggest a mild stroke. 

Other symptoms   There may be other symptoms to go on, like palpitations or a history of previous episodes. There may be a background of stress symptoms. The person might be taking medications that could have contributed to the funny turn and in some cases there will be a family history of epilepsy. 

Clear description   Easily the most important clue is a clear description of the event from someone who witnessed what happened. Of particular interest is what the person was doing when the episode occurred, how long it lasted, and whether there was loss of consciousness. 

Once the episode has passed there may be precious little to find on examination. Occasionally we might detect a narrowed artery in the neck or perhaps an irregularity in the pulse. It is much easier if the doctor happens to be on the spot or seeing the patient very shortly afterwards; there may be a low blood pressure or the person may still have speech or coordination problems. 

If there is any doubt at all about the diagnosis, several investigations can help to clarify matters. Blood tests and a cardiograph are a useful start. For more complex cases a Holter monitor is sometimes used; this is a portable cardiograph worn for 24-hours to detect hidden disturbances of the heart rhythm. Brain scans and studies of the arteries in the neck are also arranged when there is a suspicion of minor strokes. In these cases low-dose Aspirin is often commenced prior to a vascular assessment because it reduces the likelihood of a major stroke. 

Funny turns are often due to fainting spells. A drop in blood pressure occurs, the person feels woozy and may actually fall. These episodes are more likely to occur with fevers, exhaustion, stress and in people on medications. The main feature is that the person feels the faint coming on.  A thorough check-up with the doctor is still required. Simple advice about not standing up too quickly will often prevent these episodes occurring. 

Funny turns are a very complex area of medicine. Fortunately, in most cases the cause of the problem can be identified and treated.

Health tips:
 * Funny turns may be due to transient minor strokes or heart problems. It is important to see the doctor promptly so that the precise cause can be established. 

* It is very helpful to have a clear description of the funny turn from someone who witnessed it.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001