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Having recurring anxiety and panic attack. Test showed high cholesterol. Required treatment?

Nov 2013
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Practicing since : 1994
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My father (55) is having what he describes as recurring panic attacks, where he has neck pain and tension 'leading up to' a spell or attack where he momentarily loses consciousness and experiences (severe) anxiety and panic. They seem to be relatively soon after he eats (within 90 minutes) and whilst asleep. When he comes to, it takes him a few seconds to regain the ability to speak properly, and looks like his face loses muscle tension with his mouth dropping, and breathes heavily through his nose.

He's moderately active, never running or lifting weights, but he works as a builder several days a week, with the rest of the week at a sedentary office job.

He's had blood tests run, which showed high cholesterol, low B12 and enlarged red blood cells. He was treated with a course of B12 injections, but it didn't change the attacks or their frequency.

The specialist he's been seeing concluded these aren't XXXXXXX strokes, and scheduled an ultrasound on his neck and a 48 hour ECG, which both returned normal. We are awaiting results from an MRI on his head/neck and he's booked in to a sleep lab next month. Unfortunately the NHS is very slow at these kinds of things, and I've noticed over the past few weeks he's becoming more an more forgetful, today forgetting his home phone number which hasn't changed in 15+ years and leaving his debit card at the bank.

What could this be? Are there any tests we can schedule, avenues we can explore?

Posted Wed, 5 Dec 2012 in Brain and Spine
Answered by Dr. Sudhir Kumar 5 hours later

Thank you for posting the details regarding your father's medical problems. I must congratulate you on the excellent description of the events. In neurology, medical history is the most important in reaching a diagnosis.

Based on the description, there are three possibilities:

1. Mini-strokes: strokes are due to reduced blood flow to a part of brain. Transient ischaemic attacks (TIA), also referred to as mini-strokes, recover within 24 hours, mostly within a few minutes to an hour. TIA in the posterior circulation (back of brain) may give rise to transient loss of consciousness.

2. Seizure episodes- are intermittent/episodic phenomena, where there is momentary loss of consciousness with spontaneous complete recovery within a few minutes.

3. Cardiac arrhythmias- intermittent bradycardia (reduced heart rate) can lead to poor cardiac output and reduced blood flow to brain, leading to loss of consciousness.

For further confirmation of diagnosis, MRI +MR angiogram of brain, EEG, Holter monitoring, etc would be useful.

Loss of memory could be related to ischaemia of brain (early vascular dementia).

Above mentioned conditions, if diagnosed, can be well treated with medications.

I hope it helps. Please get back if you have any more queries.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad
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