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Suggest treatment for partial seizures, dizziness, hyperventilation and minor arthritis

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Posted on Sat, 23 May 2015
Question: My wife seems to be having what I would describe as partial seizures. It started with her feeling dizzy, hyperventilating, followed by these "episodes". Her blood pressure during the original onset was quite high (200 over something), I know this because I called an EMT friend and an ambulance. She was admitted for 3 days, and had the million dollar workup including multiple different ultra sounds, an MRI, CT, and EEG. Episodes did happen during the EEG, and nothing abnormal was found. Her thyroid was extremely low on blood work, she wasn't taking her medication for her hypothyroid regularly. So they assumed it was that, released her, and diagnosed her with pseudo seizers. I've made an appointment with a neurologist, its 4 days out. Its been 2 days and these episodes seem to be lasting longer now, come in waves instead of individually like before, and I see a noticeable difference in the left side of her face, especially her mouth for up to 30 minutes after one. Also her left side (whole body) gives her a tingling sensation during and for a while afterwards. She also describes that her fingers on left hand feel large afterwards. My question is, is this a normal reaction to thyroid issues, and what symptoms should I look out for that would let on she needs to go back to the hospital. I'm trying to be patient, except the hospitals diagnosis, and wait for the neurologist appointment. But its starting to scare me. She is 34, and the only health issues she has is some minor arthritis on her lower back, and her hypothyroidism.
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Answered by Dr. Erion Spaho (1 hour later)
Brief Answer:
Both ( hypothyroidism and seizure) are probable.

Detailed Answer:
Hi and thanks for using HCM.
I have read your query and understand your concerns.

Symptoms you describe could be side effects of hypothyroidism treatment, than hypothyroidism itself.

Levothyroxine ( I assume used to treat hypothyroidism) dosage should be adjusted according to clinical evaluation and TSH levels.

Since there are neurologic complains such tingling sensation, face deformity, a small possibility of your wife's symptoms remain partial sensory seizures.

In some cases it is difficult to register them in standard EEG, and special EEG study with additional electrodes could evidence them. This needs to be discussed with the Neurologist.

If you notice alterated consciousness, any leg or arm weakness, prolonged difficulty interacting with your wife, then you should get your wife back to hospital for reevaluation.

Hope this answers your question.
I remain at your disposal for further questions or clarifications.


Above answer was peer-reviewed by : Dr. Raju A.T
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Follow up: Dr. Erion Spaho (50 minutes later)
She has been having weakness in her left side, including leg, hand, and arm. I have to help her get anywhere because of it. It comes and goes with her episodes. This is not a new symptom, she had it while in the hospital and they were made aware. She also complains of pain in the back left side of her head and she feels its more then a headache. Her words are its a different type of pain, non throbbing. She describes it as if something is pushing extremely hard on the inside. Is it common for evidence of a stroke to be missed on an MRI? Is it a possibility? Or do the symptoms not align with that diagnosis?
doctor
Answered by Dr. Erion Spaho (5 hours later)
Brief Answer:
It is not a definite stroke clinically and by imaging.

Detailed Answer:
Hi and thanks for asking back.

Weakness that comes and goes of one side of the body accompanied by atypical headaches, is more consistent with a Transient ischemic attack.

MRI is the best tool in evaluating early stroke too, so, clinically and by imaging there is no definitive stroke. Transient ischemic attack is a "temporary" stroke, it leaves no permanent neurologic deficit.

What about vision of right eye of your wife, does it comes and goes too during these episodes?

Those symptoms still could be explained by partial seizures too, so, in my opinion these two possible diagnoses and diagnostic tests should be discussed with the Neurologist.

Best regards.





Above answer was peer-reviewed by : Dr. Yogesh D
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Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 4368 Questions

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Suggest treatment for partial seizures, dizziness, hyperventilation and minor arthritis

Brief Answer: Both ( hypothyroidism and seizure) are probable. Detailed Answer: Hi and thanks for using HCM. I have read your query and understand your concerns. Symptoms you describe could be side effects of hypothyroidism treatment, than hypothyroidism itself. Levothyroxine ( I assume used to treat hypothyroidism) dosage should be adjusted according to clinical evaluation and TSH levels. Since there are neurologic complains such tingling sensation, face deformity, a small possibility of your wife's symptoms remain partial sensory seizures. In some cases it is difficult to register them in standard EEG, and special EEG study with additional electrodes could evidence them. This needs to be discussed with the Neurologist. If you notice alterated consciousness, any leg or arm weakness, prolonged difficulty interacting with your wife, then you should get your wife back to hospital for reevaluation. Hope this answers your question. I remain at your disposal for further questions or clarifications.