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Could this be glucose intolerance, hypoglycemia, pre-diabetes?
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AlyssaLynette posted:

I am concerned about my husband. He is having "fainting" episodes. Let me explain a typical "episode":

1. Usually, after eating, starts with a bad headache.
2. He becomes dizzy and pale.
3. Awareness of surroundings decreases as if he's in a "fog."
4. Usually he will be sitting by then (if he wasn't already), but has been know to unexpectedly experience these symptoms too quickly to sit down and may pass out and hit the floor.
5. He will loose consciousness and this may include rapid eye movement and slight twitching in his limbs. If you lift his arm, it will drop as though he lost all muscle control.
6. He will regain consciousness after a few minutes, with confusion or a scared startle reflex.
7. Even though he regains consciousness, he will continue to have difficulty forming words and will speak and walk slowly (shuffling feet gait). This can last for 20 minutes or so.
8. Occasionally, he will go through another fainting spell.
9. After all of this, he is exhasted, still has the headache, but speech has improved.

(He reports that during his "unconcious state" he could hear and/or see the people near him, although it is shadowy and distant.)

His PCP has suggested Vasovagal Syncope, possibly stress induced. I am worried now about if this diagnosis is correct. I recall him having an "episode" every couple years or so, then once a year, then twice yearly, and the last being at 3 months. This all transpired within a 20yr span.

Twice during these 20yrs he has had the huge battery of neurological tests. The most recent testing was about 2yrs ago. All of his tests come back normal. I am very concerned as this does not seem "normal" to me.

I don't know, now if it is neurological or not. I have read about migrailepsy and it does sound like a possiblilty. However, since we are now noticing a pattern of headache and dizziness just after he eats a meal. I am going to mention it to his PCP and see if we can do a glucose tolerance test.

I may also ask for a MRI of his head and neck (mostly for reassurance). If it continues to show as normal and his symptoms don't improve, I may have to force him to go back to a neurologist.

Anyone have some input for me please...
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arealgijoe responded:
Neuro issues can be very hard to Dx.....

I have MS and it took me DECADES before any meaningfull testing was done. By then it ws a slam dunk, long standing clasic MS. I went thru vocrehab back in the 80s, they brushed/assUme'd my neuro issues were from diabetes. I was even sent to the shrinks at the VA I complained so much. They sent me back to the GPs, not nuts or even depressed, jsut adament something ELSE was wrong not shoing up on testing (no proper testing of course).

Has he been to one of the BIG speciality clinics, Mayo etc? He really NEEDS to be seen by SPECIALIST. The brain MRI, at least is a good start.

When I had my MS workup, by then they considered MS as likely, I had brain & full spine MRI, luimbar puncture, nearly a dozen vials of blood and otther tests.

Like I said NEURO issues are NOT EASY to Dx.

Gomer
 
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AlyssaLynette replied to arealgijoe's response:
Wow, arealgijoe, that's a long time to reach a diagnosis! We have had the neuro tests all done before. So far, nothing has shown up either. And, yes, we got nerves/anxiety induced vaso-vagal syncope "diagnosis" too.

I am going to start checking blood sugars before/after he eats for a while. It's not that I hope for diabetes, but I know he fears the "seizure diagnosis" even more! He is worried he won't be allowed to drive anymore...

I appreciate your input on this!
 
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teddybear200 responded:
I have had these same "episodes" once a month since Oct. Every time it happened I would test my sugars to make sure I was fine and my numbers were only 85-100. Thinking it was my sugars to blame.

I went to an EP Cardiologist who did a 24hr heart monitor and found that when I had the symptom as outlined above in your post my heart rate dropped to 45 suggesting a vagal event.

I was diagnosed with POTS an autonomic dysfunction. Also at the same time I was seeing a Neurologist for my occipital nerves and he did new MRI's of my head and neck they found out I was not getting enough spinal fluid to my brain. I was crushing my spinal cord just by turning my neck - been in a neck brace for a month now and I have not had any of my speech problems or Passing out episodes as I call them.

So there can be many things going on that can be causing your husbands episodes. I hope they can do the necessary tests to find out what is going on. It is no fun not knowing what is happening.
One day I will soar on wings of an Eagle - Deb
 
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Laurie Anderson, MSN, RNP, CDOE responded:
Hi,


I think this is unlikely to be related to blood glucose; it is more likely to neurogenic syncope, postural orthostatic hypotension (POTS), heart arrhythmia, or frank seizure disorder. He may be "afaid" of a seizure diagnosis because he's going to be told he can't drive for some time; in my opintion he should not drive or perform other potentially dangerous activities such as climb a ladder, use power tools, swim, or bathe in a tub until this is appropriately diagnosed and treated. If this were a member of my family I would pursue two avenues: a neurologist and a cardiologist. The neurologist would get the MRI/MRA and the EEG to evaluate for seizures, brain abnormalities and circulation problems. The cardiologist could set up a continuous heart monitoring system that would record the next event, a stress test for heart function, and tilt able testing for neurogenic syncope/POTS.
Kind regards, Laurie Anderson, MSN, RNP, CDOE
 
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AlyssaLynette replied to Laurie Anderson, MSN, RNP, CDOE's response:
Thank you for responding, Laurie! I understand and agree that he will need further evaluation. I want to persue the neuro test as last resort, per his wishes. He has become more "tuned" to his body's warning signals. He will pull off and let me drive if he feels odd. I know this is not going to be a long-term solution.

As far as his heart is concerned, we have had that checked a long while back and then again last year. I also think they did the POTS testing (along w/all the neuro tests) a couple years ago. We have not done the continuous heart monitoring yet.

He is going to have his blood sugars checked with hg1ac bloodwork. I am also going to push for another MRI of head, neck, and possibly spine. I am not familiar with neurogenic syncope. Please explain this to me in more detail.
 
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AlyssaLynette replied to teddybear200's response:
"I was seeing a Neurologist for my occipital nerves and he did new MRI's of my head and neck they found out I was not getting enough spinal fluid to my brain. I was crushing my spinal cord just by turning my neck - been in a neck brace for a month now and I have not had any of my speech problems or Passing out episodes as I call them."

What was the cause of this, teddybear200? My husband does have some vertebrae out of kilter in his neck...


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