SYNCOPE - SOFTBALL PLAYER

Abstract

2035 HISTORY - A 21 year old senior collegiate softball player presented after she passed out while sitting in class. She was unconscious for about 15 to 20 seconds and fell out of her chair. Her right arm was flexed and rigid but no generalized tonic-clonic movements were noted. Her eyes were open but she was not rousable. She had no nausea, vomiting, or incontinence. She was unable to see out of the left eye for about 5 minutes afterwards. Immediately prior to the episode, she felt dizzy and she felt "a weird sensation". Her vision was blurred. She did not feel well for two weeks afterward with intermittent visual disturbances, mild headache and a feeling of her perception being off. Her headache was described as intermittent episodes of pain in the occipital region on the right side lasting a few seconds at a time and occurring once every two days. She had a similar syncopal episode as a freshman. Review of systems - seasonal allergies. Past medical history - No hospitalizations or surgeries. No previous head injuries, CNS infections or intoxications. Family History - father has diabetes mellitus; mother has hypertension; brother has migraines; and a paternal uncle had a stroke at 39. CAD on maternal side. Medications - birth control pill and terfenadine (Seldane) on a prn basis. Social-Nonsmoker, infrequent alcohol. PHYSICAL EXAMINATION - Temperature 97.8° F. Pulse 60 and regular. Respirations 16. Weight 160lbs. Blood pressure 130/70 bilaterally with no postural drop. HEENT - right sided anterior chain adenopathy. Neuro - Neck is supple. Cranial nerves 2 to 12 are normal. Muscle strength in the lower and upper extremities was 5/5. Muscle stretch reflexes were 2+ in the upper extremities and 3+ in the lower extremities. Sensation to light touch, proprioception, pinprick was normal. Cerebellar testing is normal. CVS - heart sounds normal with no extra murmurs, rubs, gallops or clicks. No carotids bruits were heard. Resp - chest clear to auscultation. Seizure Disorder Vasovagal Syncope Cardiac Arrhythmia Metabolic Cause (diabetes, hypoglycemia, anemia) Cerebrovascular (TIA) TEST AND RESULTS - Na 137, K 4.2, Cl 103, Glucose 89, Bun 13, Cr 0.7, AST 62 H, ALT 27, ALK PHOS 55, WBC 3.2 L, RBC 3.64 L, Hgb 11.4 L, Platelet 252, Neut abs 1.87 L, TSH 1.76, Ferritin 29.5, Folic Acid 11.4, RBC Folate 358.6. EKG - sinus bradycardia. EEG (Sleep Deprived) - chronic paroxysmal discharges, epileptogenic in nature, left frontotemporal area. MRI - normal. FINAL/WORKING DIAGNOSIS - Partial Seizure, Secondarily Generalized. TREATMENT - Patient was referred to a neurologist and started on Dilantin. No recurrence of symptoms at 6 months follow up.