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Dr. Andrew Rynne

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Can seizures be heart-related despite suffering a concussion?

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Dr. Bonnie Berger-Durnbaugh

General & Family Physician

Practicing since :1991

Answered : 2850 Questions

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Posted on Tue, 8 May 2018 in Brain and Spine
Question: My niece is a sophomore at UNC Tarheals. She is a varsity volleyball player. This fall she received a concussion from a 90mph volleyball hit to the head and seized for several minutes. ER, CT and other scans etc.. no abnormal pathology.
Meantime unrelated, three other players have had seizures on and off the court, separate times\dates with out any head impacts. Last season another teammate experienced Extended Seizure on the court. Now due to multiple 15 min seizures, my niece has been hospitalized and still no abnormal brain pathology. Physician and nurse were present during extended seizure and found only heart rate elevated to 205 bpm. My niece could blink, point a finger but no speech. She was aware of words, names and conversation once the episode was over. Blood work was negative. The neurologist and cardiologist believe this to be heart related, possibly heart pace node. Many parents are concerned reference virus or bacterial, lymes,spinal meningitis or other neural issues not cardio related. Additionally her right eye twitches prior to an event. These girls share shower, bathroom, hot tubs together. The school does not believe these 5 different girls to be related. There was an investigation last year by the school with negative results. My next step is to provoke as CDC inquiry. Please help. Thanking you in advance for your assistance. XXXXXXX Rosenbaum.
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 2 hours later
Brief Answer:
Information

Detailed Answer:
Hello XXXXXXX

I am not a neurologist but as a primary care doctor I can provide a few thoughts on this.

Assuming none of the other girls who have had seizures did not have any significant head impacts or concussions in the past (such as in high school), then you might want to consider consulting an infectious disease specialist/immunologist. I looked up the faculty at the university hospital at Chapel Hill in the infectious disease dept. and they seem to have a somewhat narrow focus on STDs and HIV except for one group and I am copying their information here from their website page:

"Emerging Infections and Tropical Medicine
UNC’s commitment to infectious diseases research goes beyond HIV and STIs. Our investigators have made key discoveries in parasitology, virology, and bacteriology – advancing our understanding of a wide variety of important pathogens, from Plasmodium to Pneumocystis, hepatitis C to tuberculosis.
XXXXXXX Bowman, MD, MPH XXXXXXX Juliano, MD, MSPH XXXXXXX M. Lemon, MD XXXXXXX Lin, MD XXXXXXX Parr, MD, MPH

You can read about each of their areas of research here: http://www.med.unc.edu/infdis/about/faculty

Websites won't "link" here, so any that I provide, if you want to see them, you will have to copy and paste into your search bar.

You can try calling the Infectious disease dept. and asking if one of the infectious disease fellows can call you back. Ask him or her which of the doctors might be able to provide you with some information.

There are a number of infectious diseases that are associated with seizures, but these do not present with seizures - they are a symptom that happens secondary to the infection. For example, a number of viruses can cause encephalitis, and then seizures, but a person with encephalitis is noticeably ill (fever, headache, delerium). I can't think of any infections that present with seizures as a first symptom.

I'm providing a link to an article that discusses infectious diseases that can cause seizures:

https://www.ncbi.nlm.nih.gov/books/NBK83677/

There have been episodes of epidemic seizures that resulted from a toxic exposure. Here is a Dutch article about multiple people who developed seizures after ingesting what was believed to be Japanese star anise.

https://www.ncbi.nlm.nih.gov/pubmed/0000

To investigate something like that, a toxicologist might be able to help.

I agree that what you described are unusual circumstances. I hope this information helps get you started on getting more answers. We also have infectious disease doctors on healthcare magic although I believe that most of them are in XXXXXXX (this is an international website) and may be more well versed in tropical medicine, but if you would like you can repost your question and write at the beginning of it the type of doctor you would like to speak with (such as "FOR INFECTIOUS DISEASE DOCTOR ONLY..."). I know we have neurologists and infectious disease doctors. I am not sure if we have toxicologists or pathologists - at least I haven't seen any of them writing.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Bonnie Berger-Durnbaugh 2 days later
Dr. Berger_ Durnbaugh , my father was a mediocre Doc but a really great person, who really cared about his patients. You on the other hand are great in both areas, I can tell.
Thank you so much for your input and giving us a direction to look into.
One question unanswered, in all my research I can't find any corolation beginning with the heart 205 bpm or not that would present or follow with neurologic seizure episode.
I understand the role of the heart pacemaker node. But it does not connect to the brain.
My niece also had normal pulse ox of 94 during her seizures.
Simply put, with the provided info, why\how could her attending diagnosis be heart related.
You are terrific.really. thank you, XXXXXXX Rosenbaum.
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 46 minutes later
Brief Answer:
Thoughts on this

Detailed Answer:
Hello XXXXXXX and thanks for your kind comments!

Can you tell me more about her cardiac history and work up? Is the high heart rate only during seizures or are there episodes of this at other times? Has there been a holter monitor evaluation to see how often the tachycardia happens and if there are any arrhythmias noted? What tests have been done?

Sometimes with a very fast heart rate, the blood isn't being conducted adequately but with a pulse ox of 94 it appears that that isn't an issue - at least during the seizure where a pulse ox was monitored. I am mentioning this because if there is a period of anoxia (decreased oxygen flow to the brain), that can result in a seizure.

I want to share the following article for you to consider regarding cariogenic syncope (passing out) and seizure disorders:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC0000/

The vagus nerve (that nerve in the back of the throat that makes a person gag when the throat is swabbed) can cause a number of autonomic nervous system effects including tachycardia and syncope. It appears that cariogenic syncope can be tied with seizure type activity.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Bonnie Berger-Durnbaugh 2 hours later
Thank you DR. I will get the information you requested and send it to you asap.
Even with out all of the technical, labs and history, you have provided such great comments and resources for us. You are a gifted healer. Thanks again .
I will get back soon. XXXXXXX Rosenbaum
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 30 minutes later
Brief Answer:
Information

Detailed Answer:
Ok, thanks XXXXXXX Please keep in mind though that I'm not a cardiologist, but I can help with giving ideas of a next step (hopefully).

I see that when I typed cardiogenic, above, the spell checker change it - sorry.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Bonnie Berger-Durnbaugh 2 days later
Hi Dr. Berger--Durnbaugh,
great news. My niece has an appointment with a
Toxicologist specialist in two days. Turns out that she and the other girls nearly eat their weight in nearly raw fish/sushi
each week, to be on high protein good fat diet.
It's still no guarantee but, it's something that all of the girls had in common we have learned.
Since my time is short in my communication with you, I will tell you in advance that we are grateful to Health Care Magic and the high caliber of a physician that they have in you. We are also of strong belief that the mystery may be over. If true, you may soon hear or read about it in the media.
Our best wishes to you and your family for a happy holiday.
Thank you Doc.
doctor
Answered by Dr. Bonnie Berger-Durnbaugh 43 minutes later
Brief Answer:
I hope the problem is solved.

Detailed Answer:
Thank you for the update. Seeing a toxicologist is the route to go given this additional history. Good job sleuthing! Seems it would be a good idea to test for methyl mercury and certain persistent organic pollutants as well other toxins. I hope her visit with the toxicologist provides answers and a resolution to what is troubling your niece and her volley ball team! If you are willing, please send me an update after she is evaluated and tested.


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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