help with diagnosis

[Donut32]

I have a healthy 16 year old son.  A month ago he started having episodes of dizziness, shortness of breath, chest pain, he blacks out and is unresponsive for a couple of minutes.  He has muscle twitching in his arms and chest.  During the blackouts I have taken his blood pressure and it was 168/144.  when he awakes his is disoriented and has numbness in his arms and legs.  About 30 minutes later, I can retake his blood pressure and it will be normal (122/68) and he seems completely normal.  We have been to a pediatric cardioligist and neurologist and they are scratching their heads.  He  has a normal ekg, echocardiogram, head and chest ct, and a normal eeg.  
Do you have any ideas?

[Dr. Kokil Mathur]

Hi
Welcome to the MedHelp forum!
Typically this looks like epilepsy and a negative EEG does not rule out epilepsy. Take a video clipping of an ‘episode’ and show this to the neurologist. Other than that it can be cervical nerve compression high up in the cervical spine presenting with vertigo instead of pain. I would suggest you get the blood levels of the following checked if they have not already been checked: potassium, calcium, sodium, magnesium, vitamin B complex, or vitamins B1, B3, or B6 and Vitamin D. Generally deficiencies of any of the above can cause muscle twitching and spasms in localized or generalized areas of the body. Get his kidney function, parathyroid gland function and adrenal function tests done because these affect the electrolyte balance in the body. Stress, alcohol, caffeine and fatigue all cause similar symptoms. Hence if he takes alcohol or coffee then cut this down. Make him sleep at regular hours and see if it helps. Certain sleep disorders and peripheral nerve disorders due to diabetes or hypothyroidism can also be the cause. Anemia, low testosterone and ear problems too should be assessed as the cause of his symptoms.
Do discuss this with your son’s treating doctor and get him examined accordingly. Hope this helps. Take care!

[crackerjack4u2]

Hello, It has been found that an increase in sex hormones testosterone and estrogen, along with heredity, weight issues, caffeine,  diet, alcohol, smoking, lack of exercise, sleep apnea, heat, medications, eating certain foods, herbal supplements, high concentrations of B Vitamins, etc. can all be contributing factors to high blood pressure in teens/young adults.  

ALL the symptoms he is having appear to be related entirely to the rapid spike in blood pressure and the pressure itself is raising to dangerously (stroke or heart attack) ranges.

With his Blood pressure returning to normal within 30 mins it will be difficult to treat because daily blood pressure treatment may prevent the spikes but will probably cause his non episode blood pressure to bottom out and be continuously too low, which will cause similar symptoms to the one's he's having but be being caused by a low instead of high blood pressure.  The spikes he is having is caused by a rapidly increasing heart rate, and a low circulation of blood flow to the body.  

The first thing I'd recommend is to have a sleep apnea test ran on him if you haven't already.  It could be possible he has a sleep apnea problem-stops/starts breathing multiple times in his sleep, and a CPAP machine at night will increase his bodies oxygen and help lower blood pressure, feel more rested, oxygenate the bodies cells more effectively etc.    

Also, I would recommend trying to cut out ALL salt in diet, no colas,avoid caffeine, decrease consumption of B vitamines, avoid any over the counter medications unless recommended by the doctor,  no alcohol or smoking, avoiding junk food-especially chips, avoid fast food, exercise 20mins 3 times weekly-monitor blood pressure or watch closely for starting of symptoms at this time, and sit down when he feels them starting,  maintaining an appropriate weight, encourage drinking a lot of water to keep toxins flushed from his body.

I really don't know of any other options that could work as a treatment for him because his hypertension SPIKES are so quickly over, yet so dangerously high when it does occur and definitely needs to be stopped some how.  His baseline blood pressure which he has most of the time remains relatively in the "normal" range.

I Hope This Helps. Good Luck.   Have A Nice Night!