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What Causes Dizziness, Fatigue And Snoring Along With Metallic Taste In Mouth?
Posted on
Sun, 31 Jan 2016
Medically reviewed by
Ask A Doctor - 24x7 Medical Review Team
Sun, 31 Jan 2016
Answered on
Wed, 16 Mar 2016
Last reviewed on
Question : My husband experiences dizzy symptoms on occasion, which causes fatigue and metal task in his mouth. Last year he had what seemed like a seizure in his sleep. Convulsions, loud snoring, biting the tongue. It too me about 10 minutes to arouse him. He did not wet himself. This was new. He is 32 years old. We seen 2 3 neurologists. 2 just chalked it up to seizures. 1 says he believes it is something else, but has not found a cause yet. He has had every test imaginable with everything being normal. He was diagnosed with sleep apnea. He has not had any seizures like activity, until recently. I have noticed him snoring in his mask. He has had 2 seizure like activities during the day, wide awake and one when he fell asleep without the mask. How has also seen a nose and throat specialist, which say he has blockage in his nose and constant swelling of the throat. 2 days ago he had a spell at work when he was driving the work truck. They took him to the ER. Now his dr has referred him to a cardiologist and pulmonary specialist. What could be causing these spells? We truly don't believe they Are seizures. He dies have a history of traumatic injury to his right temporal lobe from an accident, and his mothers side has a history of seizures that were caused by an aneurism. His mother also gets the dizzy spells with metallic taste after word and has many heart problems (mitral prolapse). We are at a loss.. We don't know what to do or who to see. Need help!
Brief Answer:
Cardiology may disclose cardiac arrhythmias
Detailed Answer:
Good evening. Your husband's symptoms to my way of thinking (and as suggested by one neurologist) can certainly be consistent with a seizure disorder. However, it sounds as if at least 1 other neurologist is not as clear on that diagnosis therefore, another possibility to a change in mental status that appears to be seizure like could be a cardiac arrhythmia such as paroxysmal atrial fibrillation with a very rapid response which is apt to reduce blood flow to the brain and cause cognitive dysfunction and even lapse in consciousness. The easiest and most direct way of proving this would be to have your husband wear a Holter monitor for several days or as I usually have patients do, an EVENT MONITOR for 30 days.
In the mean time you should also keep track of his episodes by documenting when they happen, how long they last, and what he is doing during the episodes, including whether or not he is able to recall things you tell him directly while he is having the spell such as "REMEMBER BLUE DINOSAUR!"....In other words, by asking him to recall a specific and very vivid image during his spell we can get an idea of just what his level of consciousness may be along with functional cognition and this will help define an epileptic vs. NON-epileptic type of seizure.
Certainly the heavy breathing into his mask, tongue biting, and prolonged period it took you to awaken him as well as convulsive movements are all very suggestive of convulsive seizures and especially in the context of a traumatic brain injury which can increase the risk. Temporal lobe damage from TBI is certainly a risk factor for temporal lobe seizures which can generate both convulsive as well as nonconvulsive seizures and most commonly occur at some time long after the injury has healed.
I guess I would like to know why you think these are NOT some type of CONVULSIVE OR SEIZURE DISORDER with all the positive evidence as well as strong family history? At any rate, if he's had any EEG studies done and they've been negative just recall that the majority of EEG's tend to be negative if only a standard study is performed. If there are strong suspicions that these are NOT seizures then, I would agree with a cardiological assessment but if that is negative then, I think a full workup should proceed or be completed by neurology...at least the neurologist who believes this represents seizure disorder.
I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload more specific information regarding lab tests and diagnostic studies if done and I'll be happy to look at them in the context of your question.
Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.
Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.
This consult request has taken a total of 22 minutes of time to read, research, and respond.
Cardiology may disclose cardiac arrhythmias
Detailed Answer:
Good evening. Your husband's symptoms to my way of thinking (and as suggested by one neurologist) can certainly be consistent with a seizure disorder. However, it sounds as if at least 1 other neurologist is not as clear on that diagnosis therefore, another possibility to a change in mental status that appears to be seizure like could be a cardiac arrhythmia such as paroxysmal atrial fibrillation with a very rapid response which is apt to reduce blood flow to the brain and cause cognitive dysfunction and even lapse in consciousness. The easiest and most direct way of proving this would be to have your husband wear a Holter monitor for several days or as I usually have patients do, an EVENT MONITOR for 30 days.
In the mean time you should also keep track of his episodes by documenting when they happen, how long they last, and what he is doing during the episodes, including whether or not he is able to recall things you tell him directly while he is having the spell such as "REMEMBER BLUE DINOSAUR!"....In other words, by asking him to recall a specific and very vivid image during his spell we can get an idea of just what his level of consciousness may be along with functional cognition and this will help define an epileptic vs. NON-epileptic type of seizure.
Certainly the heavy breathing into his mask, tongue biting, and prolonged period it took you to awaken him as well as convulsive movements are all very suggestive of convulsive seizures and especially in the context of a traumatic brain injury which can increase the risk. Temporal lobe damage from TBI is certainly a risk factor for temporal lobe seizures which can generate both convulsive as well as nonconvulsive seizures and most commonly occur at some time long after the injury has healed.
I guess I would like to know why you think these are NOT some type of CONVULSIVE OR SEIZURE DISORDER with all the positive evidence as well as strong family history? At any rate, if he's had any EEG studies done and they've been negative just recall that the majority of EEG's tend to be negative if only a standard study is performed. If there are strong suspicions that these are NOT seizures then, I would agree with a cardiological assessment but if that is negative then, I think a full workup should proceed or be completed by neurology...at least the neurologist who believes this represents seizure disorder.
I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues. Feel free to upload more specific information regarding lab tests and diagnostic studies if done and I'll be happy to look at them in the context of your question.
Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.
Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.
This consult request has taken a total of 22 minutes of time to read, research, and respond.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
The question i have is, would seizures cause respiratory distress? During an episode, he foams at the mouth, periods of apnea, turns blue. I had to intervene during one because i was afraid he was going to stop breathing. When he becomes alert after an episode he is fully funtional. He even has walked to the ambulance. Before he has one he becomes dizzy, tunnel vision, throat tightens making him feel like he cant breath, starts breathing heavy and then blacks out. Now with time, he is experiencing frequent headaches and chest pain. I have seen a few seizures in my time and have never witness the ones like his. They were first occuring at night and recently he has 2 episodes in the day. I understand dx him with seizures. Most of the signs point to it, but i believe there is a medical reason that is causing them, and that is the answer we cant find right now. Since starting his Cpap, he has not had any at night for a year now. He has now only experienced 2 episodes during the day. Lab worked only showed elevated triponin levels and slight elevation of blood sugar and with potassium. He has seen an allergist also. He is currently seeing a nose and throat specialist who dx him with nose polups that are obstructing his airflow. He also dx him with stone like structures on his tonsels. He is scheduled for surgery for both. Ekg results are still pending. I am searching through other sources to find if we are missing something. That is why i am trying here. Could it be thyroid, parathyroid, slipped disc. I want to eliminate all possibilities before we accept seizures. That is why we sought out a second and third opinion from a neurologist. The first one just dx and did no further tests, even though we requested a sleep study. The second neurologist performed the sleep study and believed the episodes could be caused from the sleep apnea but couldnt prove it and didnt want to. So we finally went to our primary physician and stated we need a referral to another specialist who would be on our side and work to figure this out. Like i said, if it is a convulsive or seizure disorder, then we will accept that, but not until we are certain and have done everything possible to exclude other possibilities. I have found neurology to be a complicated field. Even if you have no electrical signs or eveidence of seizure activity during studies, doesnt mean they cant rule out seizures. My problem with that is, i have found that specialists in that field dx and dont dig futher. They choose not to take the time to find outif they are true siezures or if those seizures are being caused by something else. Cardiac, respiratory, endocrine, ect. This is my husband and it effects every aspect of his life. He was a healthy man a year ago, and now our lives have been in shambles since. I want answers. Either answer, yes they are true seizures or no they are not true seizures, doesnt matter! I just want a true, investigated, exhausted all other avenues, kind of answer!
Brief Answer:
Obtain EEG (sleep deprived) or video monitoring if episodes frequent
Detailed Answer:
Thank you for your clarifications.
Certainly, I can understand why in some cases you may feel that his episodes are not epileptic, however, some of what you describe certainly seems to be consistent with a spell of seizure or convulsive activity. The best way to document some of these would be for you to have a video on a cell phone or other form of video device at the ready and when an episode occurs to go ahead and get it on tape. You can also keep track of date, time, duration of episode from when he seems to go out to when he awakens again. These can be then, transferred into a seizure diary and taken to his neurologist for further analysis along with any video you may have.
To answer your question, seizures can certainly interrupt normal respiratory function. Often when someone is suffering from a tonic clonic episode the respiratory function simply arrests due to severe muscle contractions. The person literally stops breathing. When severe enough the patient may begin to get a bluish coloration to their lips or ashen color to the skin from lack of oxygen. When the seizure has stopped the patient usually goes into very deep snoring during what is known as the POSTICTAL PHASE.
Headaches are also a common aftereffect of an epileptic seizure as can be chest pain due to the symptoms of angina being related to the lack of oxygen flow to a heart which is under a tremendous amount of stress and usually beating rapidly but without being oxygen which increases the debt in the muscle leading to ischemic (painful) feelings in the chest.
Certainly in the workup of a patient such as your husband we will routinely obtain all appropriate chemistries and included in that will be thyroid function (not so much parathyroid- unless there is an indication or suspicion of HYPERCALCEMIA or some other physical sign that signifies its derangement). Hypo or hyperthyroidism would normally be expected to manifest in some other way other than full out convulsions. Of course, indirectly a severe dysthyroid state of some type could influence cardiac function which in turn (if altered enough) could cause the brain seize under certain circumstances. But again, discovering a primary thyroid issue by this type of presentation before it had ever been detected by other more conventional signs and symptoms would be remarkable indeed.
A slipped disc is 100% not a reason for his changes in mental status that much I will say nor can it cause loss of alert status or change in mental status by any normal physiological mechanism so you may file that as a definite "NOT" though if you found something incidentally it wouldn't XXXXXXX me but it would be just an incidental finding.
I understand your concerns and can assure you that there are many competent and dedicated neurologists who know their business very well. When we encounter patients such as your husband a thorough workup must include the ruling out of anything that can mimic a convulsive disorder. And that's why doing multiple EEG's, doing interictal PET scans, and doing MRI scan with contrast and fine cuts through the temporal lobes (we refer to that as a Seizure protocol) are part of any routine workup. A cardiac workup can be done in tandem or at any time before or after our workup since seizures and cardiac arrhythmias are comorbid conditions. Sometimes cardiac problems such as heart attacks can cause a seizure and sometimes the other way around.
You are also right about the percentage of positive hits on an EEG. For example, in a person with seizure disorder that is confirmed even.....a random EEG done on their brain will only pick up abnormal convulsive activity 30-40% of the time. A 2nd EEG will increase that yield to 50% and not until a 3rd EEG which is usually a prolonged study by that point (60-120 minutes) will we start to see something and that's when the percentage of positives goes up to about 80-85% sensitive by that time for seizure foci.
Sorry you haven't a good supply of neurologists who have satisfied you with their diligence and persistence. That's a bit unusual...we tend to have a much better reputation than that just since the field is considered somewhat "elite." Only 1% of all licensed physicians in the U.S. are neurologists by specialty training. About 0.5% are neurosurgeons. The reason for that is precisely due to the amount of attention to detail and testing that usually takes place before we ascribe a diagnosis to someone since all sorts of medical conditions can look like virtually every type of neurological malady. That's why I feel that patients generally get 2 specialists in one when there is a neurologist involved. It is so commonplace for us to automatically take the tact of ruling out other disease processes that it's just the natural part of a good workup.
If the neurologists in your area are not meeting your expectations then, I would recommend you speak with them and be clear in what you're looking for them to do with your husband in terms of comparing what he's got to everything else that he COULD have. However, if you are still unhappy with things then, you have 2 choices:
1. Go to your closest academic center such as medical school or teaching hospital and enter your husband into their neurology clinic. I guarantee the residents will have a field day with this type of presentation and they will work him up to the 9's....because that's what residents are really good at....putting in a bunch of details about a patient that only a lawyer can appreciate so they can write up a contract for them with FINE PRINT! LOL....
2. Come to XXXXXXX Ohio and I'd be happy to meet your acquaintance.
I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues.
Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.
Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.
This consult request has taken a total of 63 minutes of time to read, research, and respond.
Obtain EEG (sleep deprived) or video monitoring if episodes frequent
Detailed Answer:
Thank you for your clarifications.
Certainly, I can understand why in some cases you may feel that his episodes are not epileptic, however, some of what you describe certainly seems to be consistent with a spell of seizure or convulsive activity. The best way to document some of these would be for you to have a video on a cell phone or other form of video device at the ready and when an episode occurs to go ahead and get it on tape. You can also keep track of date, time, duration of episode from when he seems to go out to when he awakens again. These can be then, transferred into a seizure diary and taken to his neurologist for further analysis along with any video you may have.
To answer your question, seizures can certainly interrupt normal respiratory function. Often when someone is suffering from a tonic clonic episode the respiratory function simply arrests due to severe muscle contractions. The person literally stops breathing. When severe enough the patient may begin to get a bluish coloration to their lips or ashen color to the skin from lack of oxygen. When the seizure has stopped the patient usually goes into very deep snoring during what is known as the POSTICTAL PHASE.
Headaches are also a common aftereffect of an epileptic seizure as can be chest pain due to the symptoms of angina being related to the lack of oxygen flow to a heart which is under a tremendous amount of stress and usually beating rapidly but without being oxygen which increases the debt in the muscle leading to ischemic (painful) feelings in the chest.
Certainly in the workup of a patient such as your husband we will routinely obtain all appropriate chemistries and included in that will be thyroid function (not so much parathyroid- unless there is an indication or suspicion of HYPERCALCEMIA or some other physical sign that signifies its derangement). Hypo or hyperthyroidism would normally be expected to manifest in some other way other than full out convulsions. Of course, indirectly a severe dysthyroid state of some type could influence cardiac function which in turn (if altered enough) could cause the brain seize under certain circumstances. But again, discovering a primary thyroid issue by this type of presentation before it had ever been detected by other more conventional signs and symptoms would be remarkable indeed.
A slipped disc is 100% not a reason for his changes in mental status that much I will say nor can it cause loss of alert status or change in mental status by any normal physiological mechanism so you may file that as a definite "NOT" though if you found something incidentally it wouldn't XXXXXXX me but it would be just an incidental finding.
I understand your concerns and can assure you that there are many competent and dedicated neurologists who know their business very well. When we encounter patients such as your husband a thorough workup must include the ruling out of anything that can mimic a convulsive disorder. And that's why doing multiple EEG's, doing interictal PET scans, and doing MRI scan with contrast and fine cuts through the temporal lobes (we refer to that as a Seizure protocol) are part of any routine workup. A cardiac workup can be done in tandem or at any time before or after our workup since seizures and cardiac arrhythmias are comorbid conditions. Sometimes cardiac problems such as heart attacks can cause a seizure and sometimes the other way around.
You are also right about the percentage of positive hits on an EEG. For example, in a person with seizure disorder that is confirmed even.....a random EEG done on their brain will only pick up abnormal convulsive activity 30-40% of the time. A 2nd EEG will increase that yield to 50% and not until a 3rd EEG which is usually a prolonged study by that point (60-120 minutes) will we start to see something and that's when the percentage of positives goes up to about 80-85% sensitive by that time for seizure foci.
Sorry you haven't a good supply of neurologists who have satisfied you with their diligence and persistence. That's a bit unusual...we tend to have a much better reputation than that just since the field is considered somewhat "elite." Only 1% of all licensed physicians in the U.S. are neurologists by specialty training. About 0.5% are neurosurgeons. The reason for that is precisely due to the amount of attention to detail and testing that usually takes place before we ascribe a diagnosis to someone since all sorts of medical conditions can look like virtually every type of neurological malady. That's why I feel that patients generally get 2 specialists in one when there is a neurologist involved. It is so commonplace for us to automatically take the tact of ruling out other disease processes that it's just the natural part of a good workup.
If the neurologists in your area are not meeting your expectations then, I would recommend you speak with them and be clear in what you're looking for them to do with your husband in terms of comparing what he's got to everything else that he COULD have. However, if you are still unhappy with things then, you have 2 choices:
1. Go to your closest academic center such as medical school or teaching hospital and enter your husband into their neurology clinic. I guarantee the residents will have a field day with this type of presentation and they will work him up to the 9's....because that's what residents are really good at....putting in a bunch of details about a patient that only a lawyer can appreciate so they can write up a contract for them with FINE PRINT! LOL....
2. Come to XXXXXXX Ohio and I'd be happy to meet your acquaintance.
I hope this addresses your concerns and that you'll keep me in mind for future questions regarding these or other neurological/medical issues.
Otherwise, I'd appreciate your rating this interaction with a HIGH STAR SCORE and look forward to a few words of feedback. In addition, I'd appreciate your CLOSING THIS QUERY if you're satisfied with my response.
Write to me any time at: bit.ly/drdariushsaghafi for additional comments, concerns, or to provide status updates if you'd like which I would love to receive from you to see just what has been discovered.
This consult request has taken a total of 63 minutes of time to read, research, and respond.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your time on this. It was very insightful! Might take you up on your offer to meet you in XXXXXXX would be to far for us to go since we are neighboring states! Lol. I will definitley also look into another EEG and maybe even the an academic center you suggested. Thanks again and I will keep you updated.
Brief Answer:
Thank you for your kind words
Detailed Answer:
I'm not sure where you are located in Indiana but we recently went out to a place very close to South Bend to watch my son play with his Rugby team from XXXXXXX XXXXXXX University here in XXXXXXX in the Regional Playoffs. Apparently, it's a place rather well known in Indiana for its rugby fields as well as the number of tournaments and other rugby activities they host. When we went out to watch them it was BLIZZARD CONDITIONS this past November just after Thanksgiving. They ended up canceling the rest of the tournament due to subzero and icing conditions which made it far too dangerous for the kids (MEN!) to be playing...including the poor Umpire who apparently by rule is required to run around in shirts and short sleeved shirt no matter how ridiculous the weather is outside! This past weekend we again went through the state of Indiana on our way to Wheaton, Illinois for a team wrestling tournament. So you're right, Indiana is a good neighbor state of ours. You are welcome to cross our border any time for a visit. I would estimate that you're about 4 hrs. from XXXXXXX at most...of course, depending upon how far down to the South you live.
Just stay in touch if you need but I'm sure if you follow my advice and search out an Academic institution you will find a slew of experts there who can meet your husband's needs quite adequately....nevertheless, you'd love taking the road trip...if for nothing more to see the Rock 'n Roll Hall of Fame and how they've completely retooled the entire Downtown area and some of the major suburbs for this Republican National Convention which is coming up in the summer!
Please don't forget to provide some written feedback if you would....the better the score ....well, the bigger the bag of peanuts I get offered to munch on while I'm answering questions! LOL.....
All the best.
Cheers!
Thank you for your kind words
Detailed Answer:
I'm not sure where you are located in Indiana but we recently went out to a place very close to South Bend to watch my son play with his Rugby team from XXXXXXX XXXXXXX University here in XXXXXXX in the Regional Playoffs. Apparently, it's a place rather well known in Indiana for its rugby fields as well as the number of tournaments and other rugby activities they host. When we went out to watch them it was BLIZZARD CONDITIONS this past November just after Thanksgiving. They ended up canceling the rest of the tournament due to subzero and icing conditions which made it far too dangerous for the kids (MEN!) to be playing...including the poor Umpire who apparently by rule is required to run around in shirts and short sleeved shirt no matter how ridiculous the weather is outside! This past weekend we again went through the state of Indiana on our way to Wheaton, Illinois for a team wrestling tournament. So you're right, Indiana is a good neighbor state of ours. You are welcome to cross our border any time for a visit. I would estimate that you're about 4 hrs. from XXXXXXX at most...of course, depending upon how far down to the South you live.
Just stay in touch if you need but I'm sure if you follow my advice and search out an Academic institution you will find a slew of experts there who can meet your husband's needs quite adequately....nevertheless, you'd love taking the road trip...if for nothing more to see the Rock 'n Roll Hall of Fame and how they've completely retooled the entire Downtown area and some of the major suburbs for this Republican National Convention which is coming up in the summer!
Please don't forget to provide some written feedback if you would....the better the score ....well, the bigger the bag of peanuts I get offered to munch on while I'm answering questions! LOL.....
All the best.
Cheers!
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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