Tuesday, January 15, 2008

No Clue....

I ran a call last shift and I had no idea what was going on with this guy...

We get called for an unconscious. Dispatch calls us back while en route and says that the patient is now conscious. Upon arrival the patient is a mid-30's male sitting up and talking. He doesn't look as if he feels well, but not in any specific distress.

I start my assessment and found out that he has been having multiple syncopal episodes for more than a week. He had been to see his doctor and had been to the ED and was diagnosed with "Occipital Neuritis". I didn't have a clue what that was, so I started asking questions.

He said that there was something wrong with a nerve in the back of his head and that made him pass out. He was also experiencing severe headaches, sensitivity to light and nausea. The only other medical problem he had was hypertension. His only medication was a anti-hypertension med. He said that he had been diagnosed and treated for the HTN a few years ago.

The reason he had called EMS this time was because he had passed out and hit his head. He had a pretty good goose egg on the side of his head, but otherwise was OK. We obtained orthostatic vitals and there was no change. He said that he had been eating and drinking normally, no bowel or urinary abnormalities, no recent sickness and no recent trauma other than the fall. His blood sugar and 12-lead were also normal.

During all this assessment, he passed out 3 times. At first I thought he was maybe faking. But after a serious sternal rub and an extreme pinch to the web between his thumb and forefinger, I figured he was really out. Plus I've never seen a patient faking and actually smack his head against something hard enough to leave a mark and not flinch. Each syncopal episode ended within 30 seconds and he was not disorientated upon waking up.

We got him to the truck and started a line and put him on the monitor. During transport his headache, nausea and sensitivity to light seemed to get worse. I wasn't sure if it was from his condition or the bumpy/ curvy ride in the truck or both. So I turned off the lights in the back and tried to make him as comfortable as I could. He passed out several more times during transport. His vitals and 12 lead stayed normal during the episodes.

Eventually I have him 4mg of Zofran for his nausea, so he wouldn't puke in my truck and to try to make him a little more comfortable. That helped with the nausea but he still had a lot of pain. I wasn't gonna give him morphine for that and he had already taken 1000 mg of Tylenol before he called us.

We got to the hospital and turned patient care over to the nurse. The doc came in and this is usually where I make my exit but I stuck around for this one. After the doc did his assessment I followed him out and asked him what occipital neuritis was. He looked at me and said that he didn't have the slightest clue.

Since then I still don't really have a clue. I've asked several people and have done an extensive Internet search all with no real answers. So if anyone out there has any information I would be grateful. Since that call a few of my co-workers have run him for the same thing and no one seems to know what's going on...

BRM

7 comments:

chameleon22 said...

I have to wonder if this so-called "Occipital Neuritis" could in actuality be some form of migraine induced Vasovagal syndrome. You didn't mention if the pt's BP fell during the syncopal episodes.
My daughter has officially been diagnosis via tilt table. Her episodes do not seem to have any one particular trigger, and my niece also suffers from it. Niece's can be stress induced where as my daughters doesn't seem to have any connection.
Anyway, researchers are now finding that VV seems to have various and sundry triggers,and it may vary from pt to pt and episode to episode, can come on at any age or sex.

Anonymous said...

This may be stupid but could this guy have been narcaleptic?
I saw it years ago this dude face planted into his dinner plate before our arrival and during assesment he went out cold....

I don't remember any other symptoms that went along with it!

Good luck

Medic 61 said...

We miss you around the blogosphere, BRM! You coming back anytime soon!?

by: PM, SN said...

Occipital Neuritis is also called post-traumatic neck syndrome.

http://en.wikipedia.org/wiki/Occipital_neuritis

C. D. Hardison, M. D., FACEP said...

Occipital neuritis is real. About 2 hours ago I injected a 69 female with headaches for 2 yrs, negative all studies, severe DJD cerv spine. Marked tenderness C2 at mastoid, and across the nuchal ligament. The pain is severe, can trigger vasovagal (autonomic dystonia) -- similar to the syncope that occurs with carotid sinus syndrome (turn neck, pass out). Injection with steroid/marcaine can give dramatic relief of not only pain but the autonomic dystonia. Patient I did aocuple of hours ago took 15 min, had transient nausea, then in 15 min proclaimed first time headache-free in 2 years! Autonomic dystonia can occur with any pain, anxiety, stress -- including occipital neuritis. Not witchcraft or quackery -- real syndromes.

Daniel Reda said...

Interesting story. You may want to see CureTogether.com - a site we created to help people with poorly understood conditions, like occipital neuritis, compare symptoms and treatments and see live stats from other patients in similar situations.

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