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Had a syncope that followed fatigue, brain fog. CBC, MRI, ANA normal. Could it be anxiety or stress?

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I’m 25 year old male who weighs 185 and 6 feet tall. I was in great health until 5 months ago when I fainted. The ER doctor attributed the incident to a random bout of syncope. The following months have been worse. Shortly after I fainted I began having throat pressure, fatigue, brain fog, and stomach problems.

The following test have been run only to show normal results:

Urine Analysis
Abdominal Ultrasound
Celiac Test
Chest X-Ray
Head X-Ray
Throat X-Ray
Thyroid Test
Parasite Testing (I was in the Caribbean the week prior to the incident)
Hepatitis B & C

As you can see, I’ve had a thorough work up and the final diagnose came back as IBS meets Anxiety/Depression. I’m open-minded and told the doctor that I would accept her diagnosis. I began taking Cymbalta, Xanex and altering my diet. I’ve been on this routine for two months with no improvement and my throat pressure is intensifying. I’ve also begun having chest pain and my glands and lymph nodes are becoming very tender in my neck and throat. The medicines takes the edge off from an anxiety stand point but I still feel physical symptoms. My doctor stated that I should try some psychological counseling but I’m very weary of getting worse if this isn’t the underlying problem. My doctor stated at this point further testing would be like throwing darts in the dark because we’ve ruled out so many conditions. He then suggested to proceed forward with the current treatment plan and if there is a serious problem more issues will present themselves. As you can imagine, the idea of sitting around waiting for something worse isn’t appealing. I have no prior history of anxiety or depression. Any suggestions?
Posted Thu, 19 Apr 2012 in General Health
Answered by Dr. Gyanshankar Mishra 35 minutes later

Thank you for posting your query.

After going through your history, I analyze that your current problem is " chest pain and swollen glands in the neck leading to a feeling of congestion". 5 months back you had a fainting episode for which detailed work up was done and all ordered investigations were found to be normal.

At this stage I have a few questions for you,
1. 5 months back on the day of the fainting episode -
a. At what time did the fainting episode occur?
b. Did you have your breakfast / lunch on time that day prior to the fainting episode or were you empty stomach?
c. Did you have any other associated complaints like chest pain, sweating palpitations , etc. at that time?
2. Currently other than chest pain and congestion in the neck with tender lymph nodes , do you have any other complaints like - cough, cold, fever, breathlessness, palpitations, a sense of trickling in the throat, running nose, burning pain in abdomen?
3. Currently did your doctor do an oral examination / checked the lymph nodes? If not then getting an ENT (Ear, nose, Throat) examination by an ENT specialist will be very helpful.
4. Since when did you notice the lymph nodes in the neck and where are they exactly located?
5. Also get yourself auscultated (hearing through stethoscope) by your doctor for heart & lungs.

Please do let me know the answer to these queries.

Wishing you good health.
Above answer was peer-reviewed by
Follow-up: Had a syncope that followed fatigue, brain fog. CBC, MRI, ANA normal. Could it be anxiety or stress? 3 hours later
1. I fainted around 5 PM in the evening and I had been eat regularly throughout the day. The doctor at the ER also ran an electrolyte panel which showed no abnormalities. I did experience other symptoms prior to fainting such as tingling extremities and shallow breathing. I never experienced pain though. My description of my symptoms ultimately led the doctors to a diagnosis of syncope accompanied with a panic attack.

2. I have noticed difficulty breathing through my nose and a sense of breathlessness. I do occasionally have palpitations. The doctor stated they are most likely anxiety related. There has been a running nose and a sense of prickling in the throat. The chest and stomach pain would be best described as dull and achy. It isn’t affected by anything I do, it’s random. I’ve been constipated as well but that could be a side-effect of the anti-depressants.

3. The swollen lymph nodes began a 2 months ago, 3 months after fainting. The swollen nodes are located under the chin and the side of the neck below my ears and near the jaw bone. I also noticed either a very large lymph node, growth or cyst near my carotid artery on the left side; where you would check someone’s pulse. The doctor did do an oral examination and stated that the back of my throat looked a little red. She stated the redness is an indication of infection hence the swollen lymph nodes. She stated that if the throat or lymph nodes didn’t return to normal that they could biopsy the lymph node and swab the throat.

4. One further observation that was brought up to me. This happened right when I got back from Aruba. I was bit while I was there by what I thought to be mosquito’s. I never had the typical bull’s eye rash but I did develop a mild fever for a day or two after the bite. Would it be wise to test for Lyme?

I’ll have her listen to my lungs and heart and request a referral to an ENT pending your response. I know my symptoms seem somewhat all over the place so I appreciate you taking the time to further investigate. Thank You
Follow-up: Had a syncope that followed fatigue, brain fog. CBC, MRI, ANA normal. Could it be anxiety or stress? 3 minutes later
One further point, I have been dizzy as well. The doctor said its a side effect of the medicine. Trying to provide you with all of the information I have. Thanks again!
Answered by Dr. Gyanshankar Mishra 4 hours later
Thanks for the follow up.

It was really nice to get the answers from you. Presently it seems to be a case of "rhinitis with probably post nasal drip with pharyngitis".

I am presuming that you do not have any known allergies (like allergy to dust /pollen etc.) or any significant past history like having diabetes/ hypertension /asthma. You need to get yourself examined in detail by an ENT specialist (who will examine the oral cavity, nose , paranasal sinus tenderness, throat & cervical and axillary lymph nodes, and auscultation of chest too) .

Get an antibiotic course of 3 weeks, along with an antihistaminic tablet taken at night, nasal decongestant spray (if the running nose is watery and no presence of pus - after ENT consultation).

For the lymph nodes either a FNAC (Fine needle aspiration cytology) or biopsy will be required if there is no response to the antibiotic course.

Also if it was an attack of syncope and even though the ecg was normal, it would be better and safe to do a 2D ECHO to rule out any cardiac anomaly.

Do get your peripheral smear(an increased evidence of either neutrophil /lymphocyte or eosinophils will lead us to the etiology of the symptoms) & ESR (erythrocyte sedimentation rate)tested.

Mosquito bite will not cause you Lyme's disease.Bulls eye rash is the typical rash see.But sometimes flu-like symptoms, such as headache, muscle soreness, fever, and malaise will be seen without the presence of rash. You can get tested for this with Western blot and ELISA (Enzyme-linked immunosorbent assay ).

Also I would like to reconfirm the following.
1. Do you have any known allergies/ were you involved recent in some work related to dust
2.Do you smoke?
3.Was this the 1st serious health problem in your life. If not then please let me know the details.
4. What is your occupation?

If there is any additional information you would like me to know then please let me know.
Hope to see you healthy and fine soon.
Above answer was peer-reviewed by
Follow-up: Had a syncope that followed fatigue, brain fog. CBC, MRI, ANA normal. Could it be anxiety or stress? 4 hours later
I work at computer all day in an office in customer service. I had asthma as a child but out grew it it. I'm not aware of allergies but have considered doing testing to rule it out. This was the first serious health issue I've ever had. I think your advice is excellent and unless you have any other questions I am very happy with your answer :-)
Follow-up: Had a syncope that followed fatigue, brain fog. CBC, MRI, ANA normal. Could it be anxiety or stress? 3 minutes later
Forgot to mention... I do not smoke.
Answered by Dr. Gyanshankar Mishra 2 hours later

Thanks for your response.

Considering your childhood history of Asthma and correlating your findings, the etiology of Rhinitis seems to be some allergic trigger.

I have mentioned the further work up you need to do in my previous post. However if at any point in future you develop breathlessness / chest discomfort / cough visit a chest physician and get your pulmonary function tests / allergy testings done.

Hope, this helps. I wish you a very good health and very soon recovery.

Above answer was peer-reviewed by
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