Re: Blackouts

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Posted by CCF Neuro MD on April 08, 1997 at 08:45:42:

In Reply to: Blackouts posted by Pat on April 08, 1997 at 08:44:25:

: This Message was posted by: Pat - 4/2/97 1:26:00 PM

Message:
Hi there,

My 11 year old is having episodes of near blackouts.Occasionally, but not always, it begins with a bad headache. He gets
tunnel vision with sparkling lights, distorted vision, things look like he's seeing them through a backwards telescope, he gets
amnesia during these episodes and very frightened. He feels no headache during the episode. Then the headache returns when
it is over. Sometimes this happens without any headache.

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Pat, Your description of the episodes your son is suffering from are virtually a textbook description of a variant of migraine
headache that occurs in children almost exclusively. The distorted vision, sparkling lights are classic for what is called the "aura"
of the migraine. The near passing out episodes and/or confusion are neurologic symptoms arising from the migraine, which
causes constriction of blood vessels in the brain each time it occurs. As you have astutely noted, sometimes you do and
sometimes you do NOT get a headache with these symptoms. I would suggest you see A. David Rothner of the Cleveland
Clinic Pediatric Neurology department, who is an expert in the diagnosis and treatment of migraine in children. Your cardiology
visit will likely not be productive, as his symptoms are not typical for cardiac disease related fainting episodes. It is not unusual
for children with interesting migraine variants such as the one your child appears to have by your descriptions to be
misdiagnosed with a wide
variety of illnesses, especially attention deficit-hyperactivity disorder or learning disability, since the migraines often happen
while the child is in school and manifest themselves only as confusion or other mental aberrations which teachers interpret as a
lack of attention. Other possibile explanations for your sons episodes include seizures and a thing called an arteriovenous
malformation (AVM) of the brain, although these two latter illnesses are far less likely than the migraines. Because they can
mimick these migraines, however, depending on the details of any particular case, sometimes (but not always) an MRI scan of
the brain is ordered to exclude the possibility of a tumor or AVM generating the seizures or attacks. I would leave the decision
for the testing to the pediatric neurologist you choose to have evaluate and treat this illness. If it is indeed migraines as I strongly
suspect from your description, the good news is that these are very treatable and rarely result in any permanent injury
or disablility. The phone number for an appointment with Dr. Rothner (or another of our pediatric neurologists--- although
again, Dr. Rothner has specific expertise in this area) is 216-445-8125. I would suggest seeing someone soon and end what
will otherwise likely become a fruitless goosechase for you and your son.

He is diagnosed ADD/anxiety disorder/written expression disorder/gifted, and is currently on an SSRI for the anxiety. None of
the ADD meds seemed to increase his attention or focusing abilities, and he did experience negative side effects with every
one.

His sleep deprived EEG was normal. He has had a MRI in the past when he had a reaction to medication (Dexedrine)which
mimicked Tourettes, that was also normal. We are going for a cardiology screening, but I expect that will be normal as well.
He has been under the care of either a Developmental Pediatrician or a Neurologist for the past 4 years. These episodes are
new.

My sister used to work at the Cleveland Clinic Headache area and suggested that I contact you for your thoughts.

Thanks,
Pat

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