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Since April I Was Having Headaches . No Over The
Question: Since April I was having headaches. No over the counter medicine was working after taking for a week. So I went to the ER and they gave me some medicine through my IV and I had a bad reaction to it. It had me jittery for several hours. Two days later I started having panic attacks. I was having panic attacks daily. Then starting in May I notice every time I would go from resting to standing my heart rate was going up very high. I went to the doctor they did EKG and ct scan and everything was normal. Then I would notice every time sitting upright or standing I would get a headache with nausea, and shoulder pain but after lying down for a few hours it would get better but as soon as I sit up or stand it happens again with the fast heart rate. A few weeks ago I had a spinal tap done with an opening pressure of 18 but everything else was normal. After the spinal tap I got a severe headache with stiff neck and had to get a blood patch and it relieved that severe headache. My question is what can be going on with me because every time I sit or stand I am very confused, I cannot focus at all, I cannot complete simple tasks at all and when standing my heart rate goes up high but once I lay down everything seems to calm down but I still be confused some.
Brief Answer:
Postural tachycardia syndrome may need to be ruled out
Detailed Answer:
Hello and welcome to "Ask a Doctor' services,
I carefully read your query.
There are two main things I am considering. The first has to do with the fact that you mentioned that spinal tap pressure was 18. Did the doctor explain the cause of this increased pressure? This would be very important information to obtain from your doctor.
On the other hand, if otherwise all the tests you mentioned (MRI, blood tests, heart check) are normal, very likely you get the fast heartbeat when you stand due to postural tachycardia syndrome.
This is a condition that may cause a lot of distress due to a fast heartbeat, fatigue, and dizziness with a change of position. It is not dangerous and most of the time the patient grows out of it.
To diagnose this, tilt table test is performed.
To conclude:
- it may be important to discuss with your doctor on the possible cause of the increased spinal tap pressure (if there is information from the CT or MRI that may further guide on the possible cause)
- if all the rest of the tests are normal then postural tachycardia syndrome needs to be ruled out with a tilt table test.
I hope this answers your query.
I remain at your disposal if further medical assistance is needed.
Regards,
Dr. Antoneta Zotaj
General and Family Physician
Postural tachycardia syndrome may need to be ruled out
Detailed Answer:
Hello and welcome to "Ask a Doctor' services,
I carefully read your query.
There are two main things I am considering. The first has to do with the fact that you mentioned that spinal tap pressure was 18. Did the doctor explain the cause of this increased pressure? This would be very important information to obtain from your doctor.
On the other hand, if otherwise all the tests you mentioned (MRI, blood tests, heart check) are normal, very likely you get the fast heartbeat when you stand due to postural tachycardia syndrome.
This is a condition that may cause a lot of distress due to a fast heartbeat, fatigue, and dizziness with a change of position. It is not dangerous and most of the time the patient grows out of it.
To diagnose this, tilt table test is performed.
To conclude:
- it may be important to discuss with your doctor on the possible cause of the increased spinal tap pressure (if there is information from the CT or MRI that may further guide on the possible cause)
- if all the rest of the tests are normal then postural tachycardia syndrome needs to be ruled out with a tilt table test.
I hope this answers your query.
I remain at your disposal if further medical assistance is needed.
Regards,
Dr. Antoneta Zotaj
General and Family Physician
Above answer was peer-reviewed by :
Dr. Raju A.T
Yes, my primary care doctor mention pots because of the increase heart rate but I don’t think it’s only pots because I have other symptoms that don’t go along with pots. I have ringing and noise in my ears at times. I have problems with the right side of my body at times. My toes on my right foot shakes all the time. I was having problems eating at times with my right hand. I feel like I’m very off balance as well. Even lying down I’m still feeling very sick most of the time. Also will pots cause severe problems concentrating, focusing, doing simple tasks just with sitting up. These issues is so severe every day I am crying because I cannot think at all. Like something is wrong with my brain. I also have facial numbness and tingling most of the time.About the spinal tap I got it done at the ER after begging the doctor to do it because I feel like I have a CSF leak. He said 18 for the opening pressure was normal. Anything over 25 is abdominal. So is 18 high pressure? Can my vitamin b1 level be low and causing this? Can any other vitamin levels or infections be causing these? Only vitamin tests my doctor have checked is b12 and vitamin d. Vitamin d was normal and b12 was high. Iron level is 10.9 so mild anemia but I know this is not severely low to be causing all these symptoms. Potassium level 3.3 but it haven’t been low this whole time I been sick. It’s been normal. I’m taking potassium supplements now. Magnesium level is around 1.8 and 1.9. I also take magnesium supplements so it want drop. My sodium level, calcium and everything else is normal. At the time I had ct scan and mri done they wasn’t looking for a csf leak they were just looking to see why I was having a severe headache. Can I have cancer, liver damage, or anything else that can be causing this? I am very concern and so anxious to find out what is wrong with me. I have three kids that I cannot take care of anymore since all this have happened. I can longer work either. Before all this I was a happy, independent, bubbly lady just with headaches all the time. I don’t understand what happened.
Brief Answer:
Increased B12 may need to be investigated as it may indicate the presence of other important conditions
Detailed Answer:
Hello and welcome back,
Thank you for the reply and the extra information provided. I understand your struggle with trying to keep up with your daily needs and responsibilities and not being able. POTS does explain the tiredness and the changes in heart rate while standing but as you mention it does not cover the rest of the neurological symptoms that you just mentioned. So, other than POTS you may need to be investigated on other co-existing conditions.
As for the spinal tap pressure: many neurological sites recon spinal tap pressure to be 8-15 mmHg when the patient is lying on one side or 20-30 mmHg when the patient is sitting up straight.
I checked again the recent guidelines and they say that normal spinal tap pressure may be up to 20 and in a few cases even 30 mmHg and that the spinal tap pressure needs to be evaluated on the clinical context to better determine its clinical significance.
If you have had MRI of the brain and spine (both are needed to rule out multiple sclerosis) then structural problems of the brain and spine are ruled out as the cause of the neurological symptoms you are mentioning.
As for the blood results: It is not mentioned which blood tests you have been doing but minimum tests needed would be thyroid panel to rule out thyroid problems (TSH and FT4) and basic metabolic profile (glucose, lipids, electrolytes, creatinine, ALT, AST, Bilirubin, etc), CBC with differential, ERS, etc.
Vitamin B12 may cause neuropathy with neurological symptoms if it is low. In your case, you mention it is high which is a very uncommon situation and in this case liver function is needed to be checked (ALT, AST, Bilirubin, albumin levels in the blood, coagulation tests, etc), abdominal ultrasound may identify liver structure problems (and kidney problems and other abdominal organs). Rare blood disorders may be associated with an increase in B12 as well, this is why CBC with differential is needed.
High B12 levels are not very recognized in official literature and doctors may not be very familiar with this but recent studies are starting to show that increased B12 in the blood may indicate important conditions.
I would recommend you to talk with your doctor on the high levels of B12 and needed investigations to determine the cause of this as some organ problems (liver, kidney) or even tumors may be associated with increased B12 levels according to some medical articles (the following link you may share with your doctor and discuss on it https://academic.oup.com/qjmed/article/106/6/505/0000 )
To conclude:
- POTS may justify some of your symptoms but the neurological symptoms that you just explained may need further evaluation
- spinal tap pressure may vary in individual patients, 18 mmHg may be normal according to recent guidelines
- increased B12 levels need investigations, as it may cause neurological symptoms and may indicate important organ problems (liver, kidney) or even blood disorders and tumors, thus you may need to talk with your doctor to consider the needed workup to evaluate the cause of it.
I hope this answers your query. I remain at your disposal in case further medical assistance is needed.
Regards,
Dr. Antoneta Zotaj
General and Family Physician
Increased B12 may need to be investigated as it may indicate the presence of other important conditions
Detailed Answer:
Hello and welcome back,
Thank you for the reply and the extra information provided. I understand your struggle with trying to keep up with your daily needs and responsibilities and not being able. POTS does explain the tiredness and the changes in heart rate while standing but as you mention it does not cover the rest of the neurological symptoms that you just mentioned. So, other than POTS you may need to be investigated on other co-existing conditions.
As for the spinal tap pressure: many neurological sites recon spinal tap pressure to be 8-15 mmHg when the patient is lying on one side or 20-30 mmHg when the patient is sitting up straight.
I checked again the recent guidelines and they say that normal spinal tap pressure may be up to 20 and in a few cases even 30 mmHg and that the spinal tap pressure needs to be evaluated on the clinical context to better determine its clinical significance.
If you have had MRI of the brain and spine (both are needed to rule out multiple sclerosis) then structural problems of the brain and spine are ruled out as the cause of the neurological symptoms you are mentioning.
As for the blood results: It is not mentioned which blood tests you have been doing but minimum tests needed would be thyroid panel to rule out thyroid problems (TSH and FT4) and basic metabolic profile (glucose, lipids, electrolytes, creatinine, ALT, AST, Bilirubin, etc), CBC with differential, ERS, etc.
Vitamin B12 may cause neuropathy with neurological symptoms if it is low. In your case, you mention it is high which is a very uncommon situation and in this case liver function is needed to be checked (ALT, AST, Bilirubin, albumin levels in the blood, coagulation tests, etc), abdominal ultrasound may identify liver structure problems (and kidney problems and other abdominal organs). Rare blood disorders may be associated with an increase in B12 as well, this is why CBC with differential is needed.
High B12 levels are not very recognized in official literature and doctors may not be very familiar with this but recent studies are starting to show that increased B12 in the blood may indicate important conditions.
I would recommend you to talk with your doctor on the high levels of B12 and needed investigations to determine the cause of this as some organ problems (liver, kidney) or even tumors may be associated with increased B12 levels according to some medical articles (the following link you may share with your doctor and discuss on it https://academic.oup.com/qjmed/article/106/6/505/0000 )
To conclude:
- POTS may justify some of your symptoms but the neurological symptoms that you just explained may need further evaluation
- spinal tap pressure may vary in individual patients, 18 mmHg may be normal according to recent guidelines
- increased B12 levels need investigations, as it may cause neurological symptoms and may indicate important organ problems (liver, kidney) or even blood disorders and tumors, thus you may need to talk with your doctor to consider the needed workup to evaluate the cause of it.
I hope this answers your query. I remain at your disposal in case further medical assistance is needed.
Regards,
Dr. Antoneta Zotaj
General and Family Physician
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Above answer was peer-reviewed by :
Dr. Yogesh D
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