Q. Are these head-reeling episodes sue to stroke, seizure or syncope?

Answered by
Dr. Shivam Om Mittal
and medically reviewed by iCliniq medical review team.
Published on Mar 11, 2018

Hello doctor,

I have consulted you over this forum regarding the health of my mother (59 years), who is under treatment for hypothyroidism (Eltroxin 50 mcg), hypertension (Olmezest 20 mg), osteoarthritis (Gemcal D3, Kondro OD) and mild anemia Hb 10.6 [11.5 - 15] (Folvite). I would like to request your kind review for some of her recent symptoms as well, which I try to summarize below along with brief history.

Early this year, she had a fever (100 to 101 F) with cold and was on Calpol 650 and Cetirizine for a few days. One morning, right after breakfast, while sitting on a chair, she started feeling reeling of the head along with darkness in both eyes, which resolved on its own after she went to bed and laid down. The same evening, when the doctor visited her for fever, her BP was 130/80 (left arm - sitting position) with pulse 102. She also had a left-sided headache, which took two to three days to settle down along with Calpol 650.

Two months later - This time she was too worried about her son's health and recovery and night sleep was affected for a couple of days. She herself was also not too well due to stomach issues, antibiotic, gastritis, lack of appetite, etc. One morning, she started having running nose along with some amount of sneezing, for which she had taken a couple of Cetirizine tablets that day.

The next day, right after lunch, while being in the sitting position itself and talking about her son's health issues, suddenly she reported to feel reeling of the head along with darkness in both eyes, followed by she was bent towards her left with left-hand palm shaking for 10 to 15 sec and was almost about to fall down, which however did not happen with help from others.

We felt for next 5 minutes or so she was in an altered consciousness, staring at something silently, although the rest of us got extremely anxious. When we tried to speak to her, she was initially making some strange sounds, followed by normal words in hoarse voice and after that she started talking normally.

However, she was crying and worrying about her son's health, although my wife was trying to console her. Later she mentioned not to have any memory of the whole incident, except the last part of consolation from my wife. She was back in normal activities in next 10 minutes, but reported to feel too tired and sleepy for at least next two weeks. As per doctor's appointment, I took her to our medicine doctor after five to six days of the incident, who classified this as a case of viral infection, noted BP 118/82 (right arm - sleeping position) and 'no H/O convulsion'.

After a week of the incident, she had four times motion (not loose motion although) on an evening and started feeling headache after that. On the next morning, she reported feeling heaviness in legs as well as the head, which was, in fact, disturbing her daily activities. When we talked to the doctor, he advised testing serum sodium (138.4) and potassium (3.72) levels, which were normal. With rest, she improved in the evening and was able to get back into regular routine.

In the following few months she had only one instance of reeling of head which happened in the morning and got cured on its own. She also had fever with cold sometime in the middle of the year, which caused her a left-sided headache, which also lasted for three to four days in spite of taking Calpol 650. Most of her BP readings during this period were around 110/80 (left arm - sitting position) and 120/72 (right arm - sleeping position), which prompted the doctor to change BP medicine to Stamlo 2.5 mg. However, due to slight swelling in feet after a month, it was changed back to Olmezest 20 mg.

Around two months ago, some of her previous issues such as gastritis, constipation, three-four times of motion resumed back. One day she woke up pretty early (4.30 AM) and felt a significant amount of reeling of the head, which lasted almost 10 minutes, before settling on its own. She also had a left-sided headache, which again took three days to settle down, even after taking Calpol 650. She visited the doctor within next few days, who noted BP 132/82 (right arm - sleeping position) and mentioned the headache symptoms are clinically similar a migraine.

The doctor suggested taking Olmezest 20 mg twice daily as her BP seemed a little higher as compared to the previous readings. He also advised for CT scan and Holter monitor for 24 hours, in case there are recurrences of reeling of head, seizure or presyncope. I have also uploaded her past six months of test reports for your kind review. She also started feeling mild to moderate pain in the waist joint (middle portion) since past one month, but I am not sure if that is relevant to our current discussion.

What do you feel about the possible cause of these incidents? Was there really a possibility of stroke, seizure or syncope, or, are these some warning signs? What should be our next step from here on?

As people at home are really scared hearing CT scan or Holter, is there anything else we could do to rule out such possibilities?

#

Hello,

Welcome to icliniq.com.

It is difficult to comment if the episodes are solely syncope/ fainting spell due to orthostatic hypotension or abnormal heart rhythm.

I agree with Holter monitoring. I would also, recommend EEG study for one hour to make sure we are not dealing with seizures.

Her hemoglobin is low and needs further workup regarding the cause. Low hemoglobin or anemia can make her more susceptible to syncope episodes.

I hope this helps.

For more information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

Hello doctor,

Thanks for the feedback. Regarding the low Hb issue, we had done a stool examination to confirm she was occult negative. However, even after 4.5 months of 'Uprise XT' and Folvite, Hb only improved to 11.1 [11.5 - 15], which again dropped to 10.6 after four months of stopping the supplements. We had also done the iron profile. Serum iron 56, TIBC 255, UIBC 199, TSI 22.5%, Ferritin 83, Vit B12 894, serum Folate 12.5, RBC Folate 883 etc. Please suggest what we could do further.

Regarding the neurological symptoms, do you also see a risk of mild stroke or TIA here? Also, do you agree with the recommendation of doubling the dosage of Olmezest 20 mg due to BP rise from 120/72 to 132/82? I have also attached a copy of her last ECG report (which is quite old) in case it reveals anything else for us. Her lipid profile (which is also old) indicates Total Cholesterol 155, HDL 39, LDL 86 and TGD 143.

#

Hello,

Welcome back to icliniq.com.

I agree with the extensive workup for the low hemoglobin. The only next thing that comes to my mind is checking reticulocytes count and do bone marrow biopsy. Of course, this is outside my expertise.

The symptoms you ask about do not suggest TIA symptoms. For TIA symptoms, they should be stroke like symptoms like face droop, one-sided arm weakness and/or speech difficulties.

I would not increase the Olmezest (Olmesartan) at this point, as this could further lower her standing blood pressure and could increase the frequency of the spells if it is related to low blood pressure on standing. The ECG is not very clear. So, it is hard to comment.

For more information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

Hello doctor,

Thanks for the detailed response. Wanted to get your view on a home test you had asked earlier. With the home BP monitor, I had checked her BP across three positions:

  1. Sitting - 124/75 (P: 66), 117/67 (P: 62)
  2. Standing - 135/90 (P: 70), 131/83 (P: 69)
  3. Sleeping - 126/69 (P: 66)

Why is her standing BP higher than other positions? Is that something worrisome and if so what should be our next step? Could that be something responsible for the incidents? However, there was no change of position involved in either case, as the earlier incident was in sitting position, while later one in the standing position all along.

#

Hello,

Welcome to icliniq.com.

Sorry for the delay in response.

I am glad you are checking the blood pressure at home. I do not find the blood pressure readings worrisome as they are still considered in the safe range.

Take care.

For more information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

Hello doctor,

Our medicine doctor had prescribed Folvite for six weeks for anemia treatment and advised to repeat CBC after that. However, as he is currently out of town for a month or so, we are not sure if it is alright to continue Folvite beyond six weeks. Considering her incidents, do you see any neurological (and/ or other in general) risk if she continues Folvite for another four to six weeks?

#

Hello,

Welcome to icliniq.com.

Yes, It is fine to continue Folvite (Folate) for the longer duration.

Hope this helps. Regards.

For more information consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

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