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Vasovagal near-syncope in a child
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Vasovagal near-syncope in a child

Hi,
I don't know if I'm posting in the correct forum. I wanted a little more specific advice than what can be offered in the pediatric forum. I have been scouring the internet to find information until our upcoming appointment, and I'm trying to make sense of it all.

In the last 6 weeks, my 4 year old daughter has had what we can best describe as "weak spells". The most recent one, I called 911.

Their best guess was that it is vasovagal in nature. Not syncope though.

Both episodes were almost exactly the same, except the last one lasted longer.

She says she wants to lay in her bed. Then she gets up and says she's sick and coughs into the toilet. Then she says her belly hurts, sits down, and her eyes begin to roll around in head as if she's going to go to sleep or pass out. Her eyes totally glaze over and she can't focus on anything. She gets extremely pale. The first episode I was able to bring her around by using a cold cloth. She then laid quietly in bed for half an hour.

The last episode, the same exact thing happened. I kept her conscious by calling her name. She was talking, saying she wanted to go to sleep. She laid on the bathroom floor, and I carried her to bed. She was turning from side to side in her bed, but her eyes were not focused and were rolling into her head. She never lost consciousness. I called an ambulance and as soon as they got here she sat up, but was still very pale and quiet and answering their questions in a very small voice. Her blood pressure was 84/40, which they said was low, but I've since read that this is a normalish bp for a child below 5% for weight and height. When she recovered, her bp was 91/50 and the next day it was 95/59, so that would make it low, right?

Vasovagal makes sense with the last episode because I had just given her dulcolax an hour before, for a cleanout as she was supposed to have a colonoscopy two days later. But it doesn't explain the first episode. We figure it could be tummy pain triggering these episodes, but the GI is saying there is nothing wrong with her.

I've read that vasovagal syncope comes on quickly, and there is a quick recovery, but these near-syncope episodes of hers last several minutes, and her recovery was quite slow. The EMT tried to get her to stand and she couldn't because she was too weak.

They did a 15 second ECG which was normal. I'm afraid that because it appears that the dulcolax was the trigger, that they didn't do a very thorough exam, and just assumed it was vasovagal.

I told them I was pretty sure it wasn't a seizure because there was no jerking, but I since found out that not all seizures have jerking. My friend said that what I was describing sounded more like post-ictal behaviour.

Has anyone ever experienced prolonged vasovagal near-syncope? Does what I'm describing fit with this? I'd hate to make an assumption like this if there's even a remote possibility it was a seizure. Any help greatly appreciated.
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My 16 year old son's near-syncope episodes last longer than a few seconds or minutes.  Some last for 10-15 minutes - but he gets presyncope "warnings" - tunnel vision, spots, feels lightheaded.  He has had a full cardio and neuro workup - being told vasovagal, but the triggers are varied.  His biggest episode was in basketball (which also gives him migraines sometimes) but he is also lightheaded on arising or standing from sitting. He is extremely fatigued all the time.  He has been measured as orthostatic  - bp drops from laying to sitting to standing - but not all the time - 2 weeks ago yes, then last week no.  Feels like racing heart, but in-office EKG and 24 hour Holter monitor says no (even though the range of hr was 48-140 - supposedly 140 is not tachycardia! He has had episodes of feeling like his head is floating away and then he says he wakes up, unaware of the passing of time, with scribbles on his school work.  

No triggers like blood, nausea or vomiting, medication -nothing to tie this stuff together. I think they just call it vasogal as a label for when they cannot figure it out.  Can you tell I am frustrated - two pediatrician, 2 cardiologist, 3 neurologists, tow ER trips...  He is drinking tons of gatorade, and other fluids, increasing salt in his diet and wearing compression hose. Also, sleeping 12-15 hours per night and is less lightheaded.  The increased fluid has really helped, but the fatigue is still there.

Sorry to not really be able to help you, just showing a different type of vasovagal "diagnosis".
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Sorry, just realized I meant to say "Has had 2 spells in the last 6 weeks"
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Avatar_f_tn
My 16 year old son's near-syncope episodes last longer than a few seconds or minutes.  Some last for 10-15 minutes - but he gets presyncope "warnings" - tunnel vision, spots, feels lightheaded.  He has had a full cardio and neuro workup - being told vasovagal, but the triggers are varied.  His biggest episode was in basketball (which also gives him migraines sometimes) but he is also lightheaded on arising or standing from sitting. He is extremely fatigued all the time.  He has been measured as orthostatic  - bp drops from laying to sitting to standing - but not all the time - 2 weeks ago yes, then last week no.  Feels like racing heart, but in-office EKG and 24 hour Holter monitor says no (even though the range of hr was 48-140 - supposedly 140 is not tachycardia! He has had episodes of feeling like his head is floating away and then he says he wakes up, unaware of the passing of time, with scribbles on his school work.  

No triggers like blood, nausea or vomiting, medication -nothing to tie this stuff together. I think they just call it vasogal as a label for when they cannot figure it out.  Can you tell I am frustrated - two pediatrician, 2 cardiologist, 3 neurologists, tow ER trips...  He is drinking tons of gatorade, and other fluids, increasing salt in his diet and wearing compression hose. Also, sleeping 12-15 hours per night and is less lightheaded.  The increased fluid has really helped, but the fatigue is still there.

Sorry to not really be able to help you, just showing a different type of vasovagal "diagnosis".
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Avatar_f_tn
My sons POTS  started out as GI issues when he was in grade school.  All tests came back fine so they labeled it 'anxiety' or 'depression'.  The Cleveland doctors ran a gastric empyting test which came back for gastroparesis.  Our regular GI doctor wouldn't even test him for that, saying it doesn't happen in most kids.  But it is common in dysautonomia.

Does she suffer from constipation?  abdominal pain?  If all other tests come back fine, see if they will run the gastric emptying test.  

Christy
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