question

[Bill_Brasky]

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Okay, I'm not fishing for a specific diagnosis but I had a question that is neurology related I thought I might give you guys a crack at:

So my Dad passed out at work the other day. He had two previous spells where he was light-headed and his whole body seemed to "pull to the left." They took him to the ER where blood, kidneys, chest x-ray, CT were all negative. Yesterday he went to an ENT who told him he had significant hearing loss (which we had already figured out) but couldn't explain the syncope. So he is getting an MRI and one with contrast today and is seeing a neurologist Tuesday.

I'm obviously not asking y'all for a diagnosis, but since I'm only an MS1 I was hoping someone could tell me the names of a couple of things that could explain the loss of consciousness for me to research over the next couple of days. Since the CT came back negative I'm not all that worried but having a couple of disease processes to research until I hear from the neurologist would help me have something to do an keep my mind from worrying. So any very preliminary ideas of things I should start looking up for my differential?

Thanks for any help,
Bill Brasky
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Second: Brasky's semen can form into a liquid human.

First: Like the guy from Terminator 2.

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Third: HE FRAMED ROGER RABBIT!

 

[Nerdoscience]

Hmmm, it is kind of reminiscent of Meniere's disease, which is marked by hearing loss and vertigo. Those could also be caused by a tumor of the 8th cranial nerve, though involving the 8th nerve and not the 7th is a difficult proposition due to their proximity, and would probably have been seen on CT.

I know that does not explain the loss of consciousness, unless he fell, and then lost consciousness after hitting his head or something.

 

[Bill_Brasky]

Hmmm, it is kind of reminiscent of Meniere's disease, which is marked by hearing loss and vertigo. Those could also be caused by a tumor of the 8th cranial nerve, though involving the 8th nerve and not the 7th is a difficult proposition due to their proximity, and would probably have been seen on CT.

I know that does not explain the loss of consciousness, unless he fell, and then lost consciousness after hitting his head or something.

Spent some time on MDconsult this morning and made me wonder if it might be an acoustic neuroma too. MRIs are the gold standard for picking those up since they can be missed if they are small on CTs I think. They are benign at least.

Hopefully its just Benign Paroxysmal Positional Vertigo since that seems easy to clear up. It is definitely peripheral vertigo, so thank God for that. I need to talk to him again and find out how bilateral or not is the hearing loss. He works in the oil industry so alot of his hearing loss throughout his life is probably occupational but it has seemed more acute of late.

Keep the comments (and the prayers if you're so inclined) coming. Thanks to all.

-Bill Brasky

 

[nycdoc22]

H

 

[Bill_Brasky]

If anyone was curious my Dad went to the neurologist today and it looks like he might be having small seizures...which isn't fantastic but is much better than a tumor or axial lateropulsion. Thanks for all the help guys.

-Bill Brasky

 

[gibber09]

Make sure they ruled out cavernous hemangiomas. Saw a 66 year old patient today who has had seizures of unknown etiology for 25+ years whose MRI showed one of these suckers...we were the first to tell her that she had this condition. Imagine going through 25+ years of seizing and not having a clue as to why, when the answer was right there in the MRI.

 

[Bill_Brasky]

He got a contrast and normal MRI, so if it was there hopefully they caught it. He gets an EEG this Friday. I've been hearing that neurology is getting better and better at managing seizures, is this true? How good is the medication at preventing seizures entirely?

-Bill Brasky

 

[matakanan]

well what did the ENT say about his hearing loss?...a generalised decrease? or a hearing loss of either left or right ?

 

[Bill_Brasky]

well what did the ENT say about his hearing loss?...a generalised decrease? or a hearing loss of either left or right ?

Generalized neural hearing loss in both sides, most probably related to being around extremely loud oil derricks for most of his professional life, and never wearing hearing protection when we were out at the rifle range or shooting clays. It seemed to get worse lately, but he thinks that is because his hearing loss has reached a critical mass, so to speak.

-Bill Brasky

 

[PainDr]

The MRI and EEG should provide a diagnosis or at least narrow the possiblities.
His symptoms might suggest Meniers, but the hearing loss may be occupational and therefore a red herring. Also, he doesn't really sound vertiginous. Sounds more like light headedness/dysequalibrium which would suggest involvement of the posterior fossa/brain stem, autonomic nervous system or heart. Tumors and vascular malformations should show up on the MRI. He should also have a carotid duplex and MRA/MRV to rule out vascular insufficiency. If everything comes back negative, he'll need a cardiology consultation with holter monitoring until he has another episode.