You know, it's been two years since I went through a pretty thorough round of tests to figure out what was going on in my head to cause the seizures. And in the end we found out that they're always there in my brain, but when other people can actually see me have them it's secondary to something else going on that allows the seizures to escape their little brain-pen. So, recently I've been doing a little extra research starting with the diagnosed syncope and the observed cardiac arrhythmia from my tilt table test (which, when I get my act together will be available to view under the medical stuff). I have a feeling I'm about to add an entry for "cardiologist" to my emergency contact numbers. Bleh.
Anywho, here's where we start with this and how it relates to my particular situation:
For the Regular Joes:
Syncope (SEEN-co-pee) is unconsciousness caused by a lack of blood flow to the brain. It can be caused by an irregular heart beat or a drop in blood pressure.
What Happens:
If someone is passing out from syncope they may have had other symptoms that could help determine the cause:
1. contributing factors like low blood sugar, dehydration, overactivity, anxiety, overheating, etc
2. unusual sensations that happen before the syncope like nausea, strange tastes or smells, weakness, etc.
3. injuries that might have triggered a stress response like accidentally slamming your finger in a window
4. seizure activity or other uncontrolled physical aspect like staring into space, twitching, typical seizure, or loss of bladder control
5. post-seizure symptoms like irregular heartbeat, cold and clammy sensation, drowsiness, pain, confusion
other post-fainting symptoms like sweating, paleness, slow heart rate
Common syncope is typically caused by both a slow heart beat and low blood pressure in combination with high volumes of blood being somewhere else. . . like around the stomach for food digestion or in the legs and feet when standing. . . and the heart/veins can't get it relocated fast enough for what the body is trying to do. People who experience this kind of fainting may first:
1. feel sick to their stomach
2. feel tired/lethargic
3. feel overly warm or sweaty
4. note a decrease in hearing
5. note a decrease in vision
A person can lose control of their bladder during regular fainting, but if it's accompanied by seizure activity, strange tastes or smells, or confusion upon waking, then the patient likely has a systemic nervous system problem > go to a neurologist.
If a person faints with loss of bladder control, but is alert upon waking, then the patient likely has a cardiac arrhythmia > go to cardiologist.
For the Scientific Joes:
From the National Institute for Neurological Disorders & Stroke (NIH):
Syncope is the temporary loss of consciousness due to a sudden decline in blood flow to the brain. It may be caused by an irregular cardiac rate or rhythm or by changes of blood volume or distribution. Syncope can occur in otherwise healthy people. The patient feels faint, dizzy, or lightheaded (presyncope), or loses consciousness (syncope).
From Hurst's The Heart, 11th ed. (Fuster, et al):
In assessing the patient with syncope, one determines if there were precipitating factors, premonitory symptoms, injury with the episode, seizure activity or incontinence, or a postictal state. . .Brief, unsustained seizure activity can occur with syncope due to a cardiac arrhythmia.
The patient may be incontinent during cardiogenic syncope, but an aura, sustained tonic-chronic movements, tongue biting, and confusion or drowsiness after the event are more characteristic of syncope due to central nervous system disease. In contrast, return of consciousness to the alert state is prompt after reversal of the arrythmia causing cardiac syncope. The common faint (vasovagal syncope) results from bradycardia and hypotension caused by excessive vagal discharge. It is often associated with some precipitating event such as a "heavy" meal in a warm room and has brief premonitory signs and symptoms such as nausea, yawning, diaphoresis, and sometimes the feeling of decreased hearing or vision. . .Following a fainting episode, the patient may be pale and diaphoretic and have a slow heart rate. A history of similar episodes during the preceding several years is common in patients with vagal syncope.
Where I Fall on the Checklist of Symptoms:
1. triggers such as low blood sugar, dehydration, overactivity, anxiety, overheating, etc = CHECK!
2. experiencing strange tastes or smells, weakness, etc. before passing out = NOPE!
3. injuries that might have triggered a stress response = CHECK!
4. typical seizure, or loss of bladder control = (not consistently, but . . . ) CHECK!
5. post-seizure symptoms like irregular heartbeat, cold and clammy sensation, drowsiness, pain = CHECK!
6. post-seizure symptoms like confusion = NOPE!
7. other post-fainting symptoms like sweating, paleness, slow heart rate = CHECK!
8. preliminary common syncope symptoms of nausea, overly warm, decrease in hearing/vision = CHECK!
9. preliminary common syncope symptoms of lethargy = NOPE!
Conclusion: Freakin' arrythmia all over the place. The puzzle now is to find out if Keppra (which blocks calcium in neural pathways to prevent/reduce seizures) is responsible for some of the increased arrythmias (because calcium triggers the heart muscle to "squeeze" and people with adequate or overabundance of calcium don't have arrythmias).
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