Recurring symptoms (episodic symptoms)

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What is it about ?

Episodic symptoms are symptoms that recur regularly, at varying intervals. They are generally benign. Let us quote for example the fainting

and the crises of headache.

Serious malignant diseases tend to progress over time. They are rarely present for many years, and are usually not episodic. This doesn’t mean that episodic symptoms are always harmless. Seizures in a person who hasepilepsy, for example, can have serious consequences. This is the reason why the doctor will always try to find the cause, and if necessary, start an appropriate treatment.

Classification of episodic symptoms

  • Fainting : it is most often a reaction of the blood circulation and the central nervous system to certain factors, for example fainting at the sight of blood;
  • Symptoms due to too low blood sugar (hypoglycemia);
  • Symptoms related to heart or lung diseaseeg chest pain;
  • Symptoms related to blood circulation, for example temporary disturbance of blood flow in the brain (transient ischemic attack, TIA) or drop in blood pressure when standing up (orthostatism);
  • Symptoms related to central nervous system, for example epileptic seizures, dizziness or crises of headache or from migraine ;
  • Transient amnesia : transient episode with memory loss, which the person does not remember;
  • Psychological causes.

How to recognize typical episodic symptoms?

  • Fainting
    • THE’fainting is usually caused by a stressful situation, such as a blood test or an event associated with strong emotions.
    • The person does not feel well, becomes pale, begins to sweat, and eventually loses consciousness. Most often, fainting is short-lived, and the person recovers in less than a minute.
    • Possible triggers are dehydration andanemia.
  • Sudden fall by stealing the legs (drop attack)
    • A sudden fall from stooping of the legs is a sudden loss of muscle tone due to a mild disturbance in the blood supply to the brain.
    • The patient literally collapses. However, he remains fully aware.
  • Too low blood sugar level (hypoglycaemia)
    • THE’hypoglycemia is accompanied by a rapid pulse, sweating, a feeling of hunger, nausea, visual disturbances, tremors, of headache, confusion …
    • It goes away immediately if the person eats or drinks something sweet, which raises the blood sugar level.
  • Symptoms of heart disease
    • Heart disease can be responsible for loss of consciousness short-lived, with or without chest pain and / or palpitations which may be rapid or irregular.
    • Most often, there are no warning symptoms, such as sweating or paleness, and the person regains consciousness quickly.
    • Contractions of the limbs are possible.
    • Since heart disease is present, symptoms may return quickly.
  • Drop in blood pressure when standing up (orthostatism)
    • Orthostatism causes sudden dizziness and a feeling of weakness when the person goes from lying or sitting to standing.
    • This mainly happens in older people who are taking different types of medicines.
  • Symptoms of diseases of the blood vessels of the brain (transient ischemic attack, TIA)
    • They are often characterized by the loss of nerve (neurological) function. Some functions may be temporarily impaired, depending on the region of the brain that is affected.
    • Examples are a sudden feeling of weakness in the muscles, a sudden fall from the legs (drop attack), visual disturbances, speech disturbances and dizziness.
    • This often lasts between 1 and 10 minutes, and the symptoms are already gone by the time the doctor arrives.
  • Epileptic crisis
    • A epileptic crisis always starts off brutally, with a loss of consciousness and convulsive movements of the arms and legs. The patient is at risk of injury. Sometimes he loses his urine.
    • After the seizure, the person is confused, and they don’t know what happened.
    • A typical seizure lasts about 1 minute.
  • Headache
    • the headache is a very common recurring symptom.
    • In the event of a primary headache, there is no explanation. the headache still has the same characteristics.
    • The secondary headache can have many causes, for example an abnormality of the blood vessels in the neck or in the head.
    • The migraine occurs as a seizure and can last for a relatively long time. Sometimes the migraine attack is preceded by other disorders, such as flickering light, abnormalities in the field of vision, transient loss of sight, a feeling of paralysis, a change in hearing, etc. This is called a migraine with aura. The migraine attack most often occurs within an hour of the aura. In the migraine, it is usual that the aura always presents itself in the same way and that the headache be identical from time to time.
  • Transient amnesia
    • This is an episode lasting a few hours to a day that the person has no memory of. She asks the same questions all the time, but other than that, she behaves normally.
  • Vertigo
    • a Vertigo violent is triggered by changing the head position, following a problem with the vestibular system, the organ that ensures the body’s balance.
    • Sometimes there is an urge to throw up.
    • Most often, the seizure does not last more than a few minutes.
  • Psychological causes
    • Dizziness of psychological origin is usually preceded by a feeling of anxiety, panic or a fit.hyperventilation.
    • The clinical examination does not show any abnormality.

How is the diagnosis made?

Usually, the doctor can make the diagnosis based on your answers to specific questions:

  • How often does this happen?
  • How does it start?
  • Do you feel when this is going to happen?
  • How long does it last?
  • Are there other symptoms at the same time?
  • Do you take medication ?
  • Have you been diagnosed with one or more health problems?
  • Are there other cases in the family where the same recurring symptoms appear?

If the answer is not clear, a more in-depth examination will often be necessary. Sometimes, several diagnoses are indeed possible.

After a general clinical examination, the doctor may also decide to order a blood test, to perform an ECG (recording of the activity of the heart), to schedule additional cardiological and neurological examinations, to give you an X-ray and a CT scan. (CT scan)… Depending on the results, the doctor will refer you if necessary to a doctor specializing in the problem which concerns you.

Source

Foreign clinical practice guide ‘Differential diagnosis of episodic symptoms’ (2000), updated on 08/28/2017 and adapted to the Belgian context on 07/19/2019 – ebpracticenet


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