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14 year old with fainting episodes. Overactive vagus nerve present. Had a concussion after head injury. Suggestions?

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Hello Doctors, I am concerned about my 14 year old niece. (very active in sports, no previous medical hx, + for period over a year now. Only medical hx is a mild concusion she received when she sneezed too hard and hit her forhead on the granite counter 2 yrs ago) Earlier in the spring this year, she started passing out...while she was playing sports or if someone bumped into her to hard. During a baseball game, she got hit in the knee with a softball and that caused her to pass out. My sister took her to the Dr then and they dx her with an overactive vagus nerve. Over the past few weeks, she has passed out more often and no longer with activity. Today, she was doing lay ups at practice and passed out . The school called my sister and said they were having a hard time getting her to wake up...she passed out a total of 6 times before they got her to the hospital. Previous times, she would be dizzy or have CP but kept on playing whatever game she was in. My sister said this time she was really tired and kinda glassy eyed at first. They live in a rural area & the ER doc gave her a liter of NS and sent her home to f/u with her primary MD.
About a month ago she saw a Neurologist, without doing any testing he agreed the the vagus nerve dx. Also, earlier in the summer she had an Echo that was WNL.My sister says that the spells have never been accossicated with my niece's period. And unfortunately, I'm not sure how long she is out because no one has really timed it. According to my sister, probably just a few minutes. No loss of bladder control or AMS after the each episode.
I really feel like something is going on ....any suggestions?
Posted Wed, 11 Apr 2012 in Child Health
Answered by Dr. Sujeet N Charugulla 3 hours later

Thanks for your query.

I shall make an effort to provide you with good professional recommendations specific to your questions.

Looking at the history, my only wonder is about the neurologist who has not felt the need to do any tests. I feel your niece needs to be investigated. I would like perform a few tests to rule out some conditions that might be causing her recurrent loss of consciousness:

1. What is the status of her head injury - probably scan of the brain may be helpful.
2. Blood glucose tests/diabetes testing to rule out undiagnosed diabetes.
3. EEG(Electroencephalogram)/brain wave scans - sometimes absence seizures of low threshold can be near to passing out.
4. If vagus nerve etiology - any nerve conduction tests to see the integrity.
5. Blood pressure readings - hypotension can be another cause.
6. Blood tests - Hemoglobin and cell counts. (Tiredness associated)

It is good to hear that Echo was normal, but a complete heart check up that includes EKG / Holter monitoring done under the guidance of a cardiologist would be needed if neurological evaluation comes normal.

Discuss with her primary healthcare provider about these tests. If they have been done, I will be able to answer your query better if you could upload the results of these tests here.

Yet again, I duly appreciate your query to me, I do hope that you have found something useful to help you and I shall be glad to answer any further apprehensions.

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