Patient's Query
Hello doctor,
Extreme lightheadedness (not vertigo), sometimes a feeling of nausea, and feeling like I am going to black out any second. These symptoms hit me in very intense 20 to 30 seconds waves and then go away. I get these episodes about 7 to 10 times a day and they completely stop me in my tracks when they happen because I feel like I am seconds away from blacking out. These episodes come completely random and are not provoked by postural changes or anything else specific. All my blood work including vitamin levels and hormone levels have been normal.
Cardiac: I have had numerous electrocardiogram (EKGs), two D-Dimer tests, an echocardiogram, a carotid doppler, and a 30 day event monitor. All was normal. Neurologic: Basic in-room neurological exam by the neurologist, head computed tomography (CT) no contrast, magnetic resonance imaging (MRI) focused on brain and inner ears no contrast and an electroencephalogram (EEG). All normal. ear, nose, throat (ENT): Basic exam of ears and sinuses with a scope, videonystagmography (VNG) vestibular testing. All normal. When I get these episodes, my blood pressure and oxygen levels are normal. I am not dehydrated, not diabetic, not anemic, and electrolytes are normal along with all other blood work. Kindly suggest what has to be done.
Kindly help.
Hello,
Welcome to icliniq.com.
I read your question carefully and would explain that considering your performed cardiac tests, many disorders have been excluded (an inner ear disorder, epilepsy seizures, a cardiac disorder, thyroid dysfunction, etc.).
Coming to this point, I would recommend performing a head-up tilt test to investigate for possible orthostatic intolerance. If this test results negative too, I would recommend considering panic attacks as a possible cause. You should discuss with your doctor on the above tests.
Thank you.
Patient's Query
Thank you doctor,
I really appreciate the reply. I forgot to include that I actually have had the tilt table test as well and they did not see anything abnormal. Is there anything else at all you can think of that could be causing these symptoms?
I have told my, neurologist, that I wanted an magnetic resonance angiography (MRA) to test for things like vertebrobasilar insufficiency but my neurologist said that my symptoms do not match that and is not needed I guess. Kindly give your inputs.
Kindly help.
Hi,
Welcome back to icliniq.com.
Thank you for the additional information. Coming to this point, we can definitely exclude orthostatic hypotension.I would not recommend performing an MRA (magnetic resonance angiography), because it is not necessary, and it has also some risks related to the gadolinium contrast. I am sure that it will result normal, even if you performed it. I would recommend considering panic attacks as a possible cause of your complaints.
Thank you.
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Answered byDr. Aida Abaz Quka
Medically reviewed byDr. K. Shobana
Same symptoms don't mean you have the same problem. Consult a doctor now!
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