Brief Answer:
Probably vasovagal, however, other things should be ruled out

Detailed Answer:
Hello,

There are a number of things that could've caused this type of episode.

1. Medications- If any of the listed medications you're taking are less than 30 days old in your regimen. Or, if any of the dosages of your medications have been changed (especially INCREASED) in the last 30 days then, the possibility that either 1 or more of the drugs were responsible for this event or the interaction between these medications caused the faint.

2. Dehydration/Hypoglycemia- You may have been very low on fluids or had not properly eaten or missed too many meals in the past few days. Demonstrating this as a possibility could be done by getting what are called orthostatic blood Pressures at your doctor's office as well as getting some blood work done to look at blood glucose, your Hemoglobin A1C, and standard electrolytes in search of a metabolic disorder that could've caused the event.

3. Infectious agent- Perhaps you were battling a recent cold, flu, or even upper respiratory infection and in combination with potential dehydration or lack of full nutrition went to a point where blood pressure was affected and became suddenly low causing the faint. Again, blood work done could show the smoking gun by looking at your CBC and differential. If I were your physician I might also consider doing a URINALYSIS to see whether or not an occult bladder or kidney infection could be present that needed to be addressed.

4. Brain Electrical Aberrancy- If you actually lost consciousness (and that's what it sounds like happened) then, I would also highly recommend a test called an EEG be performed. I believe the likelihood that this was a seizure or epileptic event is very small. Nonetheless, any lapse of consciousness in an otherwise, healthy individual for even a brief period of time with nausea and an aura of speech difficulty must be ruled out. Now, in your case there is an additional consideration the Wellbrutin medication which does have a well known side effect of Lowering Seizure Thresholds in Susceptible Indivuduals. Given what happened, in my practice I would look for a way of either eliminating or changing the Wellbrutin based on this event.

5. TIA- Transient Ischemic Attack (Ministroke)- This could be assessed by going to a neurologist for a complete evaluation and possibly getting an MRI of the brain with DIFFUSION/PERFUSION weighted images. Even up to 30 days out from an event it is still possible to find abnormalities on this sequence of images when read by an experienced neuro-radiologist and especially if a neurologist can find something focal on examination....sounds like an unlikely possibility by how you've described things, but I would definitely work you up for this possibility if nothing else pans out first.

6. Cardiac arrhythmia- again, a bit less likely if you are otherwise, healthy, have no family history of heart disease, and say that you exercise regularly, however, the fact is whenever a person faints as you've described the possibility of an arrhythmia such as paroxysmal atrial fibrillation (PAF) must be considered and I would submit you for at least an EKG and maybe even an event monitor.

7. Anxiety/Panic- If your presentation to this group of people was a first time event and if you are a person who is nervous of public speaking then, an accelerated anxiety or panic like attack may have come over you causing the Vasovagal event to occur. This should be the very last diagnosis to consider after everything else has been examined for and ruled out.

If I've provided useful and helpful information to your questions could you do me a huge favor by CLOSING THE QUERY and be sure to include some fine words of feedback along with a 5 STAR rating? Again, many thanks for submitting your inquiry and please let me know how things turn out.

Hope I have answered your query.
Let me know if I can assist you further.

Regards,
Dr. Dariush Saghafi, Neurologist

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