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Syncope

Jun 19, 2013 - 0 comments
Tags:

syncope

,

dizzy

,

vertigo

,

Headache

,

stress

,

bradycardia

,

Left hemiparesis



Syncope

On June 4th 2013, I was in class taking an algebra exam when I experienced tremendous posterior cervical pain with a right frontal headache. I felt dizzy and tried to collect myself. I woke to find that I had passed out for a few minutes, long enough for someone to go to the office and summon 911. My chair had been removed from where I was positioned at my desk. I did not fall out of the chair and witnesses state I just slumped forward.
I was able to walk with assistance to the office to await the ambulance. I didn’t feel dizzy, just disoriented and confused about what happened. The paramedics arrived and immediately checked my vital signs. My BP was 150/90, HR 90’s. EKG showed LVH per one medic. Glucose was 98mg/DL. I was transported to Morton Plant Hospital and in ER had several FAST exams performed, all were negative for a CVA. I was unable to provide urine and was straight cath’d with less than enough for an adequate sample. IV of NS started and awaited admission to the floor. CT of the head was negative.
Once in the room, I had to move my bowels. I felt very dizzy and the room was spinning. A bedside commode was brought and I was relieved. Labs coming back were unremarkable per the nurse. I became very nauseous during the afternoon and by evening was vomiting the fluid. The vertigo was more intense and I had to wedge my head against the bed and side rail to gain relief. The nurse gave me meclizine IV and Tylenol for the headache. I remained on the IV at 100 ml/hr during my 50+hour admission. Tuesday evening I had a carotid Doppler study which showed no narrowing. During the night, the nurse woke me as my heart rate was in the 30’s. Hemiparesis was noted with left side involvement. Right side was pins and needles.
On Wednesday June 5 in the afternoon, I noticed my vision in the right eye was blurred and was seeing double. I summoned the nurse to document the event. The neurologist came to my room and ordered a MRI. The cardiologist ordered an echocardiogram during to the bradycardia. All the tests came back negative.
I was ready to leave by Thursday. The vision was still double; I still had an unsteady gait and was listing to the right. Headache wasn’t nearly as bad and nausea had eased. By late afternoon the cardiologist gave me the thumbs up for discharge as did the neurologist. I was given a RX for Meclizine and advised to follow up with my PMD.
I could not walk well; I was weak and was leaning to the right. There was not any facial droop, grips remained strong and equal. BP was 106/60, HR in the 70’s diplopia remained. I noticed that my right eyelid drooped and right pupil is slow to respond to light. Left paresis continues and the right is tingly. I have no temperature sensation from midline to the left. Actually cold items illicit pain where they touch my skin on the left. Swallowing is impaired even with saliva often choking.


PMH:                         hyperlipidemia-Pravachol 10 mg hs,
                                   Insomnia -Alprazolam half of 0.25mg hs
                                   SAD- Paxil 10 mg hs.
                                   Testosterone IM injections 200 mg twice a month
                                   Vitamin B-12 injections twice a month
                                   Daily Vitamins
                                   Rare ETOH use
                                   Cigarillo user (less than 4/day)
                                   Sedentary lifestyle, borderline agoraphobic
                                   S/P Gastric Sleeve Gastrectomy  2/2009. Total weight lost 168 lbs.
                                   S/P sleep apnea with CPAP
                                   S/P hypertension, all resolved with weight loss
Family Hx:      Father passed two years ago at 82. COPD, Heart Disease, CHF
                        Mother 79, COPD, Asthma
                        Three sisters 54, 56, 59 one with CML-Leukemia
Patient:            52, lives alone, full time student, unemployed, good diet primarily vegetable                      





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