Desperate for help !

[kyhusband]

My wife has been passing out several times a week for over a year now. She has seen two different cardiologists ( one was a Electrophisiologist)  and two different nurologists. She has had MRI, MRA, Cat Scan, ECG, EEG, EKG, arterial pressure test, TEE, EKG moniter for two weeks. Complete blood workup also showing a slight low level of glucose and Thyroid test shows high normal range. Symptoms are feeling of the spins moments before going unconcious. Sometimes numbness in extremities before passing out can occur or feeling hot before hand. Sometimes all the symptoms before passing out. Unconcisness can last for up to 45 seconds with twitching as she regains consciousness followed by a severe headache of a 10 on a scale of 1-10. while hospitialized, morphine and or Demerol was used to treat pain with much more pain relief from the Demerol. No one can figure out what is wrong with her or how to treat her. HELP us please !!

[kyhusband]

thank you for your reply. yesterday she dis have two tilt table tests, one of them was measuring her arterial pressure during the test and there was no change in BP or Pulse during the episoids. thank you, Sean

[Michael J. McWilliams, M.D.]

I won't be able to give you a diagnosis on the internet if more than 4 other specialists have seen her face to face and haven't figured out it yet.  The work up syncope can be very difficult.  If she is passing out that frequently, it should be hard to eliminate cardiac causes with a home monitor.  If she passed out wearing a monitor and her heart rhythm is normal (no arrhythmia), normal EKG, has a normal echo and normal stress test that eliminates pure cardiac causes.

I would have to leave it to the neurologist to determine if they think it is neuro related.

If the cardiac and neuro work up is negative, that leaves autonomic or nervous system related causes  -- vasovagal, neurocardiogenic syncope, orthostatic (blood pressure drop), pots (postural orthostatic tachycardia syndrome -- heart rate goes up and blood pressure drops when standing).  The is a tricky area because non of the specialties really take ownership of problems like this and they are often  hard to treat.  There are autonomic specialists around the country, some of which work in cardiology, neurology, or independent.  An academic center is probably the best place to start.  Call the cardiology department and ask which doctor specializes in syncope.  In complicated cases it is not uncommon to see one doctor and then be referred to someone in the same center that might have a little more expertise in a particular area.

A tilt table test might be another test that is helpful.

Bad headaches are not typical of any cardiac form of syncope that I am aware of.

Hopefully this points you in the right direction.  Good luck.