What Causes Difficulty In Focusing And Reading, Brain Fog And Exhaustion?

Posted on Thu, 23 Nov 2017

Question: My 30 year old daughter has challenges focusing reading complains of Brain Fog is easily exhausted . Have been to nuero specialist endocrinologist gone on no sugar no alcohol no gluten diet she is slim and trim 5'10: but struggling to keep up at work she fainted at work a month ago she went to her regular dr and her pulse was quite low -under 50 she went to a cardiologist to check out - had a stress test all fine she is diagnosis fatigued of being told there is nothing wrong its almost 2 years now I am a dad who is very worried also checked blood for lymes disease nothing suggestions ?

Answered by Dr. Ishu Bishnoi (1 hour later)

Brief Answer:
Differential diagnosis and approach

Detailed Answer:
Hi XXXX, thanks for asking from HCM.

I can understand your concern. Your daughter is having repeated episodes of "brain fog". As she has been evaluated by neurologist, endocrinologist and cardiologist, I assume most blood tests have been XXXXXXX However please let me know her MRI brain report.

Brain fog can occur due to many conditions like

- Low haemoglobin or anaemia
- Hypothyroidism
- Transient ischemic attack
- Multiple sclerosis
- Stress headache or tension headache
- Lyme disease
- Eye disease like refractive error, optic neuropathy.
- Anxiety and panic disorder
- Depression

To pinpoint the cause, we need few investigations like

- Hemoglobin level
- Lyme serology (already done and normal)
- Eye examination
- Thyroid function test (T3, T4 and TSH level)
- CT angiography brain
- Or MRI brain with MR angiography
- Psychiatric evaluation if every investigation is normal.

You have already mentioned that her most blood investigations are normal. You can send me the reports or you can check her haemoglobin and thyroid level.

If you find, every mentioned test has been done, you should consult ophthalmologist and Psychiatrist for evaluation of eye and functional causes. These might be the cause behind her brain fog. Please let me know, if you have already discussed it or not.

Hope it will give you some insight about it. If you have any doubts, do let me know.
Please send me her reports.
Thanks. Take care.

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Ishu Bishnoi (22 hours later)

Contnuing .. she is taking a small dose related to her thyroid but my impression is this is a side issue not anything that has shown an improvement that is noticeable. Her MRI and Cat scan all normal. I believe she is going to get a second opinion on cardiologist as the doc she saw basicly dismissed her out of hand. He had a roomful of older people needing pacemakers and she is young and tall. Our thoughts were as she had fainted and had slow heart rate and complains of and does have cold hands that bradycardia could be an answer - would explain symptoms - but her check up with our old school cardiologist didn.t show anything that got his attention. I think this is worth pursuing to rule out. At the bottom of your list is depression and we are open to this possibility but our daughter is Rx averse and she gets that from me - your thoughts

Answered by Dr. Ishu Bishnoi (2 hours later)

Brief Answer:
Cardiac disease and depression

Detailed Answer:
Hi XXXX, welcome back.

I got your point. Cardiac disease can be a possibility as there was bradycardia and fainting episode. But it is less likely in your daughter as

- She is Young
- Slim
- Her investigations and cardiac workup were normal.

Still we should rule it out as diagnosis is not confirmed. ECG and ECHO will be primary investigations. If doubt, TMT can be done.

Possibility of depression and anxiety is high. It is because she has normal investigation and known thyroid disorder (Thyroid can cause both). So you should consult psychiatrist for it. You can explain it to your daughter and explain about medications also. Psychiatrist will also help her to start medication if diagnosis is proved.

So go for it.
Hope it will help her. If any doubts, do let me know.,
Thanks. Take care

Above answer was peer-reviewed by : Dr. Yogesh D