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My 9 year old son has been having dizziness ,

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Posted on Sun, 17 Mar 2019
Question: My 9 year old son has been having dizziness, shortness of breath , rapid heart beat , fatigue/weakness, muscle pain(when this happen) and 1 time involuntary hand movement . What could he possibly have ? I have done cat scan and results are normal , blood is normal . I don't know what else to test.
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Follow up: Dr. Dariush Saghafi (0 minute later)
My 9 year old son has been having dizziness, shortness of breath , rapid heart beat , fatigue/weakness, muscle pain(when this happen) and 1 time involuntary hand movement . What could he possibly have ? I have done cat scan and results are normal , blood is normal . I don't know what else to test.
doctor
Answered by Dr. Dariush Saghafi (4 hours later)
Brief Answer:
Possible episode of partial seizure

Detailed Answer:
Good evening.

I'm sorry to hear that your son is experiencing these problems. You haven't said much in terms of exactly how long these spells have been happening and whether everything you described comes on suddenly or if he can feel something beginning to happen such as a warm feeling rising from his stomach and coming into his chest? When you say DIZZY do you mean he is feeling FAINT or is he complaining either he or the room are spinning?

As a neurologist one of my first thoughts to look into for a patient such as your son would be to send him for an EEG study. I would consider doing a PROLONGED 60 min. study WITH SLEEP DEPRIVATION (which means your son only has to awaken 3 hours before his usual wake up time on the day of the test). If he is having these spells at least 3 times a week then, it would even be reasonable to put him in the hospital hooked up to a 24/7 video monitor that can also record his brainwaves to see if any patterns or abnormal discharges show up.

I would also be concerned in your son that he may have some time of cardiac problem which could be in the form of an electrical conductance aberrancy or something more structural within the heart itself. I might even consider something that would be completely different from either heart or epilepsy and that might be something called a PHEOCHROMOCYTOMA which is hormone secreting tumor that would be located within his adrenal glands.

Therefore, in your son I would speak with his pediatrician and ask that he be seen by at least a NEUROLOGIST (pediatric and even epileptologist) as well as a pediatric CARDIOLOGIST (could possibly use a 12 lead EKG, HOLTER MONITOR for 30 days, and an echocardiogram (with bubble study). If neither of those specialists can find any problems then, I would recruit an endocrinologist to look into the pheochromocytoma as a possibility IN ADDITION to checking your son's THYROID function and other endocrine systems to make sure that something may not causing something completely unsuspected. I would also ask that an MRI with fine temporal lobe cuts using GADOLINIUM CONTRAST be utilized since CT scan are poorly sensitive to more subtle or posterior fossa pathologies.

Also, before your son gets injected with gadolinium XXXXXXX for the MRI of the brain make sure he ordered a CREATININE for his kidney function in addition to what is called an ESTIMATED GLOMERULAR FILTRATION RATE. This is to prove that the integrity of his kidneys is able to handle the XXXXXXX substance. Some people are allergic to the XXXXXXX and bad things can happen if the kidneys are fully operational after being injected with the XXXXXXX

One other thing that would be HUGELY helpful is for YOU to start keeping a close RECORD on paper and using your own VIDEO CAPABILITIES with your telephone or camcorder if you have one of when these episodes occur. Give as much detail as you can to include the time, date, ,and DURATION of the episodes. Did he have any strange or unusual behaviors BEFORE things started to happen? And how about when the episode stops...can you describe how he is and how coherent he is to questions or commands....along with any other characteristics of his physical or mental state of mind right afterward. How long does it take for him to get back to normal. Is he exhausted after one of these episodes or do they not affect him or stop him from doing things with his friends or family.

And so, if I've provided useful or helpful information to your question could you do me the favor of CLOSING THE QUERY along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserving? I would be interested in getting some updated information on how things are going in the next few weeks if you can remember to drop me line at: www.bit.ly/drdariushsaghafi

You can always reach me at that address for this or other questions. I wish you the best with your son as soon as possible.

This query required 37 minutes of professional time to research, assimilate, and respond in complete form.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Dariush Saghafi (0 minute later)
Brief Answer:
Possible episode of partial seizure

Detailed Answer:
Good evening.

I'm sorry to hear that your son is experiencing these problems. You haven't said much in terms of exactly how long these spells have been happening and whether everything you described comes on suddenly or if he can feel something beginning to happen such as a warm feeling rising from his stomach and coming into his chest? When you say DIZZY do you mean he is feeling FAINT or is he complaining either he or the room are spinning?

As a neurologist one of my first thoughts to look into for a patient such as your son would be to send him for an EEG study. I would consider doing a PROLONGED 60 min. study WITH SLEEP DEPRIVATION (which means your son only has to awaken 3 hours before his usual wake up time on the day of the test). If he is having these spells at least 3 times a week then, it would even be reasonable to put him in the hospital hooked up to a 24/7 video monitor that can also record his brainwaves to see if any patterns or abnormal discharges show up.

I would also be concerned in your son that he may have some time of cardiac problem which could be in the form of an electrical conductance aberrancy or something more structural within the heart itself. I might even consider something that would be completely different from either heart or epilepsy and that might be something called a PHEOCHROMOCYTOMA which is hormone secreting tumor that would be located within his adrenal glands.

Therefore, in your son I would speak with his pediatrician and ask that he be seen by at least a NEUROLOGIST (pediatric and even epileptologist) as well as a pediatric CARDIOLOGIST (could possibly use a 12 lead EKG, HOLTER MONITOR for 30 days, and an echocardiogram (with bubble study). If neither of those specialists can find any problems then, I would recruit an endocrinologist to look into the pheochromocytoma as a possibility IN ADDITION to checking your son's THYROID function and other endocrine systems to make sure that something may not causing something completely unsuspected. I would also ask that an MRI with fine temporal lobe cuts using GADOLINIUM CONTRAST be utilized since CT scan are poorly sensitive to more subtle or posterior fossa pathologies.

Also, before your son gets injected with gadolinium XXXXXXX for the MRI of the brain make sure he ordered a CREATININE for his kidney function in addition to what is called an ESTIMATED GLOMERULAR FILTRATION RATE. This is to prove that the integrity of his kidneys is able to handle the XXXXXXX substance. Some people are allergic to the XXXXXXX and bad things can happen if the kidneys are fully operational after being injected with the XXXXXXX

One other thing that would be HUGELY helpful is for YOU to start keeping a close RECORD on paper and using your own VIDEO CAPABILITIES with your telephone or camcorder if you have one of when these episodes occur. Give as much detail as you can to include the time, date, ,and DURATION of the episodes. Did he have any strange or unusual behaviors BEFORE things started to happen? And how about when the episode stops...can you describe how he is and how coherent he is to questions or commands....along with any other characteristics of his physical or mental state of mind right afterward. How long does it take for him to get back to normal. Is he exhausted after one of these episodes or do they not affect him or stop him from doing things with his friends or family.

And so, if I've provided useful or helpful information to your question could you do me the favor of CLOSING THE QUERY along with a few POSITIVE words of feedback and maybe even a 5 STAR rating if you feel it is deserving? I would be interested in getting some updated information on how things are going in the next few weeks if you can remember to drop me line at: www.bit.ly/drdariushsaghafi

You can always reach me at that address for this or other questions. I wish you the best with your son as soon as possible.

This query required 37 minutes of professional time to research, assimilate, and respond in complete form.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Dariush Saghafi (10 hours later)
Thank you for the detail information . Let me add more info . He started to have these heart racing and shortness of breath in January . This would happen when he would get super anxious and at school . So in February about a week and a half ago he started to tell me he feels weak which always happen when he is settling down for bed. So a week ago while settling for bed he would start heavy breathing and shortness of breath which would last for about 10-15mins . From there he goes to sleep Throughout the night he would be very restless in his sleep and also he would go to the bathroom a lot.
In the morning getting ready for school he would start once more shortness of breath , weakness and heart racing . From there we would have him stay home and maybe he would have 2 more episode those lasting 15mins. When he had the last episode thats when his hands would move involuntarily but deep breaths and breathing into a paper bag helped. Yesterday was a better day as he had none throughout the day until last night when he was getting ready for bed he had one that lasted XXXXXXX 30secs. 3 deep breaths and he was fine.

Would that what I describe still be in the same thoughts as your diagnosis ?
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Follow up: Dr. Dariush Saghafi (0 minute later)
Thank you for the detail information . Let me add more info . He started to have these heart racing and shortness of breath in January . This would happen when he would get super anxious and at school . So in February about a week and a half ago he started to tell me he feels weak which always happen when he is settling down for bed. So a week ago while settling for bed he would start heavy breathing and shortness of breath which would last for about 10-15mins . From there he goes to sleep Throughout the night he would be very restless in his sleep and also he would go to the bathroom a lot.
In the morning getting ready for school he would start once more shortness of breath , weakness and heart racing . From there we would have him stay home and maybe he would have 2 more episode those lasting 15mins. When he had the last episode thats when his hands would move involuntarily but deep breaths and breathing into a paper bag helped. Yesterday was a better day as he had none throughout the day until last night when he was getting ready for bed he had one that lasted XXXXXXX 30secs. 3 deep breaths and he was fine.

Would that what I describe still be in the same thoughts as your diagnosis ?
doctor
Answered by Dr. Dariush Saghafi (1 hour later)
Brief Answer:
Think of WPW but I'd still do the same workup recommended earlier

Detailed Answer:
Many thanks for the extra clarification of your son's case.

After reading the additional symptoms I am led to recall something that could have these symptoms called WOLFF-PARKINSON-WHITE SYNDROME (WPW). This is a cardiac condition that results from having an additional electrical pathway in the heart for conduction which bypasses the normal conducting system's usual setup. It's something that occurs from birth and usually genetically determined but it typically doesn't appear in people under their teens or early 20's. It can occur at any age. It's considered a relatively rare cardiac conduction abnormality but your son's symptoms that suddenly kick on as you describe are reminiscent of when I've seen patients having episodes of their WPW acting up which can be seen when they are in monitored units. I've never seen this happen in a 9 year old but again, I'm not a pediatric cardiologist so something like this would clearly escape me during training for the most part and certainly in real life.

However, it really does sound like a heart thing could be going on although I would still be in favor of doing a tandem workup for seizures in parallel with the cardiac workup. A good cardiologist will know how to work him up with a minimum of disruption to his school attendance, etc. There are devices he can wear that can be worn to school that will record information so he doesn't necessarily have to be in a hospital.

Here are some of the more common symptoms experienced by people with typical WPW: chest palpitations, Dizziness or lightheadedness, Shortness of breath, Fainting, Fatigue, and Anxiety. More aggressive cases may have additional symptoms of:
Chest pain, Chest tightness, Difficulty breathing, and fainting.

My question to you (which you will need to find out by figuring out a good way to ask him since he's a child....is whether or not these episodes are truly tied to his feeling ANXIOUS BEFORE everything else happens.....OR, does he suddenly feel his heart going off to the races which THEN, makes him feel ANXIOUS? Would it be possible for his teachers or the school nurse to get a video clip of him having one of these episodes. Is he coherent and able to speak and appropriately respond to questions? Can he intelligibly speak?

See if you can train your son to alert his teachers or someone in school when he feels something coming on so that someone can stay and observe him while it's going on. AND ask him while this is happening about what he feels in his chest as well as trying this maneuver (called Valsalva).

Have him practice to BEAR DOWN by tightening up his belly muscles and holding his breath HARD at the same time. Tell him to pretend that he were straining on the toilet. He would need to bear down very strongly for this for at least a period of 15-20 seconds to see if the spell subsides or feels like it's subsiding, or he feels palpitations or fluttering in the chest slowing down, or IDEALLY going it away? It will undoubtedly come back but if this maneuver works then, he may have discovered a way to control these episodes a little bit instead of just letting it run its course.

If these are partial or complex partial seizures then, he may act confused or have a lot of difficulty comprehending what anyone is telling him to do when they happen and he may have a glassy stare or the famous 1000 yd stare with widened eyes maybe even some subtle lip smacking or unusual twitchy movements of the hand, the face, or the mouth.

Everything else I also recommended in terms of laboratory and blood workup looking into the idea of something like a pheochromocytoma and also acquiring an MRI of the brain with gadolinium contrast using FINE CUTS through the temporal lobes (looking for MESIAL TEMPORAL LOBE SCLEROSIS etc.) should still be considered for a full workup....UNLESS there is a clear and present conclusion that can be drawn right away when doing the initial cardiac screening that definitely puts the action in the heart in one way or another.

Once again young lady, if I've provided useful or helpful information to your question would you not to forget to CLOSE THE QUERY and RATE THE DOC (That's Me! LOL) with a few words of POSITIVE feedback and maybe even a 5 STAR badge if you feel it is deserving? And for sure I'm be interested in getting updated information on your son in the next few weeks if you can remember to drop me a line at:

www.bit.ly/drdariushsaghafi

You can always reach me at that address for this or other questions. I wish you the best with your son and hope you can get the little guy settled a bit...must be extremely unsettling for him to suddenly feel so uncontrolled.

This query required 67 minutes of professional time to research, assimilate, and respond in complete form.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
doctor
Answered by Dr. Dariush Saghafi (0 minute later)
Brief Answer:
Think of WPW but I'd still do the same workup recommended earlier

Detailed Answer:
Many thanks for the extra clarification of your son's case.

After reading the additional symptoms I am led to recall something that could have these symptoms called WOLFF-PARKINSON-WHITE SYNDROME (WPW). This is a cardiac condition that results from having an additional electrical pathway in the heart for conduction which bypasses the normal conducting system's usual setup. It's something that occurs from birth and usually genetically determined but it typically doesn't appear in people under their teens or early 20's. It can occur at any age. It's considered a relatively rare cardiac conduction abnormality but your son's symptoms that suddenly kick on as you describe are reminiscent of when I've seen patients having episodes of their WPW acting up which can be seen when they are in monitored units. I've never seen this happen in a 9 year old but again, I'm not a pediatric cardiologist so something like this would clearly escape me during training for the most part and certainly in real life.

However, it really does sound like a heart thing could be going on although I would still be in favor of doing a tandem workup for seizures in parallel with the cardiac workup. A good cardiologist will know how to work him up with a minimum of disruption to his school attendance, etc. There are devices he can wear that can be worn to school that will record information so he doesn't necessarily have to be in a hospital.

Here are some of the more common symptoms experienced by people with typical WPW: chest palpitations, Dizziness or lightheadedness, Shortness of breath, Fainting, Fatigue, and Anxiety. More aggressive cases may have additional symptoms of:
Chest pain, Chest tightness, Difficulty breathing, and fainting.

My question to you (which you will need to find out by figuring out a good way to ask him since he's a child....is whether or not these episodes are truly tied to his feeling ANXIOUS BEFORE everything else happens.....OR, does he suddenly feel his heart going off to the races which THEN, makes him feel ANXIOUS? Would it be possible for his teachers or the school nurse to get a video clip of him having one of these episodes. Is he coherent and able to speak and appropriately respond to questions? Can he intelligibly speak?

See if you can train your son to alert his teachers or someone in school when he feels something coming on so that someone can stay and observe him while it's going on. AND ask him while this is happening about what he feels in his chest as well as trying this maneuver (called Valsalva).

Have him practice to BEAR DOWN by tightening up his belly muscles and holding his breath HARD at the same time. Tell him to pretend that he were straining on the toilet. He would need to bear down very strongly for this for at least a period of 15-20 seconds to see if the spell subsides or feels like it's subsiding, or he feels palpitations or fluttering in the chest slowing down, or IDEALLY going it away? It will undoubtedly come back but if this maneuver works then, he may have discovered a way to control these episodes a little bit instead of just letting it run its course.

If these are partial or complex partial seizures then, he may act confused or have a lot of difficulty comprehending what anyone is telling him to do when they happen and he may have a glassy stare or the famous 1000 yd stare with widened eyes maybe even some subtle lip smacking or unusual twitchy movements of the hand, the face, or the mouth.

Everything else I also recommended in terms of laboratory and blood workup looking into the idea of something like a pheochromocytoma and also acquiring an MRI of the brain with gadolinium contrast using FINE CUTS through the temporal lobes (looking for MESIAL TEMPORAL LOBE SCLEROSIS etc.) should still be considered for a full workup....UNLESS there is a clear and present conclusion that can be drawn right away when doing the initial cardiac screening that definitely puts the action in the heart in one way or another.

Once again young lady, if I've provided useful or helpful information to your question would you not to forget to CLOSE THE QUERY and RATE THE DOC (That's Me! LOL) with a few words of POSITIVE feedback and maybe even a 5 STAR badge if you feel it is deserving? And for sure I'm be interested in getting updated information on your son in the next few weeks if you can remember to drop me a line at:

www.bit.ly/drdariushsaghafi

You can always reach me at that address for this or other questions. I wish you the best with your son and hope you can get the little guy settled a bit...must be extremely unsettling for him to suddenly feel so uncontrolled.

This query required 67 minutes of professional time to research, assimilate, and respond in complete form.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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My 9 year old son has been having dizziness ,

My 9 year old son has been having dizziness, shortness of breath , rapid heart beat , fatigue/weakness, muscle pain(when this happen) and 1 time involuntary hand movement . What could he possibly have ? I have done cat scan and results are normal , blood is normal . I don't know what else to test.