Vasovagal syncope

[govmentchedda]

Any of you frogs had any experience with this? My son had an episode Wednesday night that we initially thought was a seizure, but signs are pointing towards vasovagal syncope.

[A_B]

We had i it happen Once. Scary stuff but the calmness of th nurse put us at ease.

[govmentchedda]

I was at the USMNT game, so I didn't see the episode (and get as freaked out as my wife did), and when I met them at the hospital he seemed ok. He was tired, but OK. They ran an EEG all night and noticed some abnormalities in his occipital lobe while he slept, so they're ordering an MRI. It sounds like this could be pretty easy to manage assuming the MRI comes back clear, but still, seeing your kid compromised is pretty scary.

[BSF21]

Sending good vibes to you and yours Chedda.

Keep us posted.

[mister d]

I assume I'm not the only one who didn't know the term ...

Vasovagal syncope occurs when you faint because your body overreacts to certain triggers, such as the sight of blood or extreme emotional distress. It may also be called neurocardiogenic syncope.

The vasovagal syncope trigger causes your heart rate and blood pressure to drop suddenly. That leads to reduced blood flow to your brain, causing you to briefly lose consciousness.

Vasovagal syncope is usually harmless and requires no treatment. But it's possible you may injure yourself during a vasovagal syncope episode. Your doctor may recommend tests to rule out more serious causes of fainting, such as heart disorders.

[The Sybian]

Any of you frogs had any experience with this? My son had an episode Wednesday night that we initially thought was a seizure, but signs are pointing towards vasovagal syncope.

Yup, I've had it 4 or 5 times. Once was in the hospital post-surgery, so it was witnessed by nurses, and they kept me for 2 days and ran every test imaginable with multiple neurologist follow ups. It looks scary, but isn't much more than fainting with muscle spasms, but it is not a seizure. First time it happened, I felt like I pulled every muscle in my body.

As I understand it, it's just a horribly designed defense mechanism, where the blood moves down from the brain. I've always gotten it as a reaction to medical procedures or injuries. The good news is, you can feel it coming on and can prevent it by laying down with your feet up, and ice packs on your head and neck help. Actually had nurses prevent an episode a couple weeks ago. I had my sinuses scoped, and 10 seconds afterwards started to have a syncope reaction. Doctor just calmly said, "oh, you're going vasovagal" and 2 nurses immediately came in, put my chair back, put ice on the back of my neck and forehead. At other times, nurses freaked out, this one just said "you are the third one today, happens all the time." The feeling of the scope getting stuck in my sinuses and having the doctor scraping it through triggered the response.

Anyways, point is, it's nothing to worry about, and something preventable if your son feels the symptoms coming on. You can see symptoms, like color draining from the face, and instant profuse sweating. The sensation is really hard to describe, just a very weird overpowering nausea, light headedness and flood gates of sweat.

PM if you want to discuss.



ETA: Damnit, D.

[Gunpowder]

I assume I'm not the only one who didn't know the term ...

Vasovagal syncope occurs when you faint because your body overreacts to certain triggers, such as the sight of blood or extreme emotional distress. It may also be called neurocardiogenic syncope.

The vasovagal syncope trigger causes your heart rate and blood pressure to drop suddenly. That leads to reduced blood flow to your brain, causing you to briefly lose consciousness.

Vasovagal syncope is usually harmless and requires no treatment. But it's possible you may injure yourself during a vasovagal syncope episode. Your doctor may recommend tests to rule out more serious causes of fainting, such as heart disorders.

I had it in my trivia set before replacing it with myocardial infarction. Seemed too difficult.

[govmentchedda]

Sounds like it was most likely a seizure and not vasovagal syncope. MRI came back clean. He's out of the hospital now, and back to his normal self. Thanks for the good vibes, frogs.

[Pruitt]

That's fucking great to hear!!

I had a horrifying incident with Vaso Vagal 6 years ago or so.

Bottom line is that an ER doctor figured it out, but for the 6 hours or so before that, I thought that I was either dying or having a heart attack.

My trigger was retelling a stressful family issue months after things had cleared up. It was almost as if my brain suddenly let itself freak out once things had cleared up. Hung up the phone and collapsed. Had to crawl to the phone as I couldn't stand up. In the ambulance, my heart rate was in the low 30s.

Awful.

Interestingly, one of my golf buddies was away on business recently when his 9 year old son had a vaso vagal incident.

And Sybian is right - ultimately it is nothing to worry about... but for me anyway, I always worry about having another one. BUT knowing what to expect means that you will be less freaked out if there is a next time.

[brian]

Glad it's mundane chedda. I haven't had one in three years thanks to surgery, medication and luck but I think I might be able to warn someone if I was going to have a grand mal seizure again

[govmentchedda]

Glad it's mundane chedda. I haven't had one in three years thanks to surgery, medication and luck but I think I might be able to warn someone if I was going to have a grand mal seizure again

Luckily for us, they aren't talking grand Mal, and from what we can tell this could be a one off. I can't imagine what you've been through.

[TT2.0]

hope this is a one off small problem and the kid is ok ched

[brian]

I'm kind of upset I even mentioned my shit. It's not even a comparison for a grown ass man and a kid. I'm glad he's OK.

[govmentchedda]

I'm kind of upset I even mentioned my shit. It's not even a comparison for a grown ass man and a kid. I'm glad he's OK.

Don't be. Malfunctioning brains are scary as hell, and it's nice to be able to talk about it with someone who's been through something similar.

I was really hoping it was vasovagal syncope and not a seizure, because of concern for the future for him. My wife (who saw the episode) never really bought into my optimistic hopes that it wasn't a seizure. When the overnight EEG showed abnormalities she felt a little validation, (relief maybe), that they found something. She just wasn't buying that what she saw wasn't a seizure of some sort. It sounds like this is manageable for now. They gave us a prescription to administer if he has another, and said that unless it is much worse we don't need to go to the ER, but rather the neuro during normal hours.

[howard]

Hey guys. Wheelhouse here, loss of consciousness in the context of brain function and malfunction.

Chedda, glad things have settled down and nothing major/life threatening (like Brian's situation three years ago.). I have some thoughts specific to your son's case, at the end of this post.

Nearly everything said in this thread is accurate, useful, you guys have a good handle on this. I'll try and keep it brief and fill in some info.

Vasovagal syncope is very common, very scary, and very much benign. Even if an individual has multiple episodes. It is an exaggeration of a very effective evolutionary defense mechanism, (sorry syb, I see a beautiful elegance in this reflex, to force you to stop in weird threatening situations like active bleeding or hypovolemia, your body shouting 'that's a hard no!).

Doing anesthesia for colonoscopy a couple thousand of times, I see the effects of severe vagal stimulation (shoving a garden hose up the anus, inflating the colon with air so it can be visualized) combined with hypovolemia (the preparation before the procedure to clean out your colon) and an anesthetic technique that causes peripheral vasodilation, relative central hypovolemia and lowering blood pressure (the technique has the advantage of speedy onset and offset, against these disadvantages), I deal with this reflex arc all the time. Kinda like Russell Westbrook, I don't like it, but I respect it.

Any syncope (loss of consciousness) that is not easily explained (immediate trauma, medical history) generally results in a wide array of tests. This is because we don't understand the brain that well. Very frequently, approaching 90% of cases of first time syncope, all those tests yield negative results. And the default diagnosis is often 'vagovagal syncope'. This is even moreso with a young healthy person.

But, if the vagus nerve, which is the major autonomic (parasympathetic) innervation of the GI system, from lips to anus, is stimulated, it results in a lowering of heart rate, heart force and blood pressure, which alone on in combination with hypovolemia (like mild dehydration on a warm day) can lower blood pressure transiently, low enough to cause one to pass out.

Almost always, it happens, it goes away in a matter of minutes, with no lasting effects (unless you bump your head or injure another body part as you faint), and although naturally very alarming, is almost always harmless.

Cheeda, one potential concern is over-intrepretation of the EEG study, resulting in a false positive, that is incorrectly sticking your son with the diagnosis of a seizure disorder. If this diagnosis is wrong, there are the consequences of long term (if not lifetime) medication to prevent a subsequent seizure, the side effects of those medications, and other issues, like drivers' license, pre-existing condition affecting health insurance (since we may well be returning to that abomination), et al.

Of course, if he actually does have a seizure disorder, and it is not treated, that is another set of problems.

Granted it was the dark ages, but in school I took an elective in EEG interpretation. One of my takeaways was the subjective nature of interpretation of the scans. Sure, some diagnoses are easy and obvious, even for a fourth-year student, but a lot of subtle findings are tough, and different reading by different doctors were not uncommon.

Of course, in this modern era, we have computers using sophisticated algos to read these things. The pros and cons of this technology should be obvious.

Further, occipital lobe abnormalities, with no symptoms (particularly visual or migrane-like symptoms) leading to a generalized seizure causing unconsciousness is (I think, this is beyond my real expertise and recent experience) is at least less common than frontal lobe abnormalities.

I do not pretend to offer a contrary diagnosis for your son. I present these points as the basis of questions I would ask were this my son. How definitive are these EEG findings? Were these interpreted purely by computer, or did a doctor review the actual waveforms? Would a second opinion by another neurologist be helpful?

I would absolutely seek a second opinion before committing to long-term treatment with dilantin or other seizure medication.

There are tremendous advantages to a diagnosis of vaso-vagal syncope over a diagnosis of a seizure disorder. Of course, allowing wishes/preference affect the judgment of the proper diagnosis is another source of error.

Best of luck, I'm sure your son will be fine regardless, and please don't hesitate if you want to speak with me about this.

h dot reynolds at earthlink dot net

[Pruitt]

Awesome post Howard.

Chedda - the good thoughts are flowing from up here. Please keep us posted.

[govmentchedda]

Thanks so much for the post, Doc. I plan on reaching out to you to prep questions for the neuro. Its going to take a real need for us to put him on antibiotics seizure meds. We generally err on the side of restraint with medicine. Obviously, if he has a few more seizures and shows a need, it's what we have to do. We're lucky to have you, and a handful of good friends that are MDs to ask questions of (2 peds, 2 radiologists, and a GP who is very open to alternative medicine). It really gives us comfort in this scary situation.

[The Sybian]

Vasovagal syncope is very common, very scary, and very much benign. Even if an individual has multiple episodes. It is an exaggeration of a very effective evolutionary defense mechanism, (sorry syb, I see a beautiful elegance in this reflex, to force you to stop in weird threatening situations like active bleeding or hypovolemia, your body shouting 'that's a hard no!).

Thanks, Doc. Of all the research I've done and doctors I've discussed this with, you are the first to point out that there is a useful reason for the response. Kind of makes me rethink Intelligent Design. On the flip side, knowing colonoscopies commonly set off the response, I have that much more reason to fear/dread getting a colonoscopy.

Cheddah, hoping this turns out to be a one off situation. My nephew used to have fevral seizures when he was younger (now 9). Went through all the tests, and basically said he would grow out of it. Been several years now without any episodes.

[howard]

You'll be asleep; you'll never know if your heart rate drops to 30. It'll just be more survival of the fittest genes.

Of course, I was at lunch yesterday afternoon, and a lady three tables over passed out, and they called out asking for a doctor.

Hope the info helps you chedda, give a call anytime.

[The Sybian]

You'll be asleep; you'll never know if your heart rate drops to 30. It'll just be more survival of the fittest genes.

Of course, I was at lunch yesterday afternoon, and a lady three tables over passed out, and they called out asking for a doctor.

Hope the info helps you chedda, give a call anytime.

And you looked down at your shoes and quickly shuffled off the opposite direction.

[howard]

And you looked down at your shoes and quickly shuffled off the opposite direction.

I wish. My friends ratted me out.

After I attended to the woman and returned to my seat, my buddy (friends since little league) said after I answered the call for a doctor, the waitress called out, 'is there a jewish doctor in the house?'

That was pretty good.

[mister d]

[howard]

nope. I more closely resemble the one without a '.'



here's a life-sized recent photo

[Johnny Hotcakes]

Hi Frogs,

I had a somewhat similar incident with my two year old a few months ago. He had been under the weather for a few days (lethargic, not eating, etc), but seemed well enough to take grocery shopping on a Sunday morning. As we were shopping I turned around and he was fully reclined in the cart seizing. Called the ambulance and once it was clear that he was postictal and stable they offered to pick up my wife (an ER doc, fortunately) en route to the hospital. He spent two days in the hospital where they did every test under the sun. The only thing they found was some blood abnormalities, which subsequently resolved themselves in a few days. Have seen a a few specialists since then, and the working theory is just that he had some sort of harsh viral infection. But we may never know. By far the scariest shit I have ever personally been involved in. Was feeling sorry for myself until we visited the hematology clinic a few times on follow ups. Seeing and interacting with those kids (and their parents) is beyond sobering.

[govmentchedda]

Glad to hear he's doing better, and that it was likely only a response to a viral infection, and not a diagnosis of chronic seizures.

[Ryan]

I hadn't clicked on this yet because I thought it was about vasectomies. Somehow it's worse. Good luck to all affected

[mister d]

"Vaginal sycophants" is what I first see most every time.

[sancarlos]

Glad he's ok, Chedda.

[blundercrush]

Glad to hear everyone's ok.

But that's what that stupid thing is called? I passed out doing first aid training to become a ski patrolman in high school, pretty good place to have it really. I couldn't remember what it's called for a long time. I can handle blood in movies but some pictures (fish hook through an eyeball, screwdriver all the way through the middle of an arm) and a lot of real life blood (my own blood in small amounts is ok, thank god, I get too many bloody noses for that to be an issue). I didn't really want to be a doctor when I grew up anyway.