What causes fever, sweats, cold hands and feet in a epilepsy patient?
She had felt dizzy during the day about 10 days ago as the day entered the evening it got worse. She then had a fever, sweats, cold hands and feet, couldn't move. Was taken to the emergency room where she was tested for a stroke. Had a cerebral tap, spinal tap, brain scans, was tested for dengee fever, blood tests, urine tests, medication level tests. All came back negative. No stroke, no dengee fever. She could not speak, move her arms, legs, anything. She could breath on her own. After 3 days very slowly her speech came back, her movement is coming back in her legs and arms. Her mind is fine. Her speech is no longer impaired. She was advised that she has an enlarged heart which is new. Her blood pressure is 140 over 62 and has a slight fever still. Very slight 99.5. She is now having physical therapy daily which is helping a lot. What is new is the enlarged heart, incontinence (she has the desire to use the rest room but when she moves to get out of bed to do so it happens in her pants.) Lastly the body temperature. No diagnosis has been provided as of today as all the tests done came back negative. So far its a mystery.
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Hello and thank you for your question. I understand your concerns. Welcome to HCM.
After carefully reading your query, I would recommend first to "solve the mystery". If this patient would come to my office, I would recommend her to be admitted to the hospital, to the cardiology ward, and have cardiac tests carried out. Anyway, in-hospital or in an outpatient manner, I would recommend the following tests, and the answers will provide us clues to the enlarged heart:
- first, the EKG, to assess the electricity and conduction in the heart, whether there are pathological changes or not;
- second, the echo cardiogram - to view the structures of the heart, chambers and valves, by size, function and motility, an exam that is substantial in confirming the enlarges heart and, also, provides even data about the origin of this problem (if it is present)
- third, the cardiac stress test - which is merely an EKG in exertion, and is taken while the patient is performing exercise. This is a test that would tell us about the probability that there is/is not a coronary artery blockage present.
- if there is tachycardia or other rhythm or conduction problems seen in the EKG, a 24-holter rhythm registration should be obtained
- if there are clues that point towards coronary artery blockages by the above mentioned tests, then it is recommended to proceed to coronary angiogram, to quantitatively assess the coronary arteries and, if needed, to treat it/them with stent implantation.
This is my opinion, to "solve the mystery".
I hope I was helpful. I am happy to help, if you have follow-up questions.
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