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What Causes Extreme Fatigue, Hiccups And A Butterfly Rash On The Face?
Question:
Hi Dr. XXXXXXX
I'm a 20 year old female who asked you for health advice after I suffered what I think was a TIA. I sought medical care at an A&E in XXXXXXX where they did an ECG, chest x-ray, CT scan of brain, and bloodwork. I have an MRI appt tomorrow and a follow up with the A&E on the 15th. As far as I know, everything looked fine. My cholestorol, electrolytes, and red cell count were all normal as was my blood sugar. All scans came back clear and the ECG was normal. I had low blood pressure but thats normal for me with POTS.
Anyway, I feel like what happened to me was potentially very serious but the doctors here dont seem to be taking it all that serious since I'm not in the loop about what other bloodwork they've done and since they sent me home with out giving any recommendations or advice. Its been 3 weeks now and most days I still feel extremely fatigued and not myself. On the days I do have energy I still go to bed early or have a nap.
Additionally, I have had hiccups for the last 3 weeks which started after my first episode or what i think was a TIA. The hiccups are infrequent, maybe 3 or 4 per hour, one at a time. They seem to ease up whenever I lie down. Do you think this could be related? Ive tried every technique to get rid of them and tried 2 different antacids with no luck.
Apart from the MRI, what can the doctors do and how will they ultimately rule out (or in) TIA?
If not TIA, what else could this have been and why am I still feeling so fatigued and abnormal?
Thanks.
XXXX
Hi Dr. XXXXXXX
I'm a 20 year old female who asked you for health advice after I suffered what I think was a TIA. I sought medical care at an A&E in XXXXXXX where they did an ECG, chest x-ray, CT scan of brain, and bloodwork. I have an MRI appt tomorrow and a follow up with the A&E on the 15th. As far as I know, everything looked fine. My cholestorol, electrolytes, and red cell count were all normal as was my blood sugar. All scans came back clear and the ECG was normal. I had low blood pressure but thats normal for me with POTS.
Anyway, I feel like what happened to me was potentially very serious but the doctors here dont seem to be taking it all that serious since I'm not in the loop about what other bloodwork they've done and since they sent me home with out giving any recommendations or advice. Its been 3 weeks now and most days I still feel extremely fatigued and not myself. On the days I do have energy I still go to bed early or have a nap.
Additionally, I have had hiccups for the last 3 weeks which started after my first episode or what i think was a TIA. The hiccups are infrequent, maybe 3 or 4 per hour, one at a time. They seem to ease up whenever I lie down. Do you think this could be related? Ive tried every technique to get rid of them and tried 2 different antacids with no luck.
Apart from the MRI, what can the doctors do and how will they ultimately rule out (or in) TIA?
If not TIA, what else could this have been and why am I still feeling so fatigued and abnormal?
Thanks.
XXXX
Brief Answer:
MRI brain with MR angiogram needs to be done.
Detailed Answer:
Thank you for getting back.
I am glad to note that all your reports are normal.
Since CT brain is normal, it rules out any major brain stroke (small ones can be missed on CT). MRI of brain with MR angiogram (of brain and neck arteries) are ideal for TIA. It can detect any small infarct (area of decreased blood supply), as well as any narrowing of blood vessels.
Hiccups can occur in brain stroke, if it involves medulla oblongata (a part of lower brainstem).
Extreme fatigue is not common with stroke, however, it can occur if thalamus or hypothalamus area are involved. Anyway, MRI would help confirm or exclude the above.
If MRI/MR angiogram come normal, then, we do not need to worry about any neurological disorder. You would then require evaluation by an internist.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
MRI brain with MR angiogram needs to be done.
Detailed Answer:
Thank you for getting back.
I am glad to note that all your reports are normal.
Since CT brain is normal, it rules out any major brain stroke (small ones can be missed on CT). MRI of brain with MR angiogram (of brain and neck arteries) are ideal for TIA. It can detect any small infarct (area of decreased blood supply), as well as any narrowing of blood vessels.
Hiccups can occur in brain stroke, if it involves medulla oblongata (a part of lower brainstem).
Extreme fatigue is not common with stroke, however, it can occur if thalamus or hypothalamus area are involved. Anyway, MRI would help confirm or exclude the above.
If MRI/MR angiogram come normal, then, we do not need to worry about any neurological disorder. You would then require evaluation by an internist.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you. My MRI is today and I know scans of my brain and cervical spine have been ordered but I don't know about the MR angiogram.
Is it possible that the TIA could have been brought on by a virus or disease? The A & E hospital sent my labs to a rheumatologist to test for lupus because it runs in my family and I've had a positive ANA in the past. The last few weeks I've been extremely fatigued, suffered joint pain especially in my knees and wrists, and most nights I have what seems to be a butterfly rash (in fact the A&E doc pointed it out to me when I was in the hospital)
If it turns out I am diagnosed with lupus, could that itself make me more susceptible to TIA? I've been doing my research and it seems there were a few risk factors for me such as being on two birth controls, having a history of migraine, and flying very frequently.
Honestly if not for the hiccups I would think its just an atypical migraine which is the doctor's current impression but hiccups for 3 weeks, starting right after my episode.. it's very strange. If that area of the brain you mentioned is affected, causing these hiccups, will it be shown on the MRI?
Thanks Dr. Kumar! Sorry for so many questions, I just want to feel normal again.
Is it possible that the TIA could have been brought on by a virus or disease? The A & E hospital sent my labs to a rheumatologist to test for lupus because it runs in my family and I've had a positive ANA in the past. The last few weeks I've been extremely fatigued, suffered joint pain especially in my knees and wrists, and most nights I have what seems to be a butterfly rash (in fact the A&E doc pointed it out to me when I was in the hospital)
If it turns out I am diagnosed with lupus, could that itself make me more susceptible to TIA? I've been doing my research and it seems there were a few risk factors for me such as being on two birth controls, having a history of migraine, and flying very frequently.
Honestly if not for the hiccups I would think its just an atypical migraine which is the doctor's current impression but hiccups for 3 weeks, starting right after my episode.. it's very strange. If that area of the brain you mentioned is affected, causing these hiccups, will it be shown on the MRI?
Thanks Dr. Kumar! Sorry for so many questions, I just want to feel normal again.
Brief Answer:
Yes, lupus can increase the risk of TIAs.
Detailed Answer:
Thank you for getting back with more information and queries.
Yes, systemic lupus erythematosus (SLE) is a known risk factor for TIAs and strokes. Repeat ANA and antidsDNA tests would help confirm or exclude SLE.
Mr angiogram (to look at blood vessels of brain) can be done at the same sitting as MRI of brain and spine, and it would take an extra 10 minutes.
Yes, birth control pills as well as migraine, both increase the risk of TIA in young women.
MRI would show the area affected (that can cause hiccups).
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Yes, lupus can increase the risk of TIAs.
Detailed Answer:
Thank you for getting back with more information and queries.
Yes, systemic lupus erythematosus (SLE) is a known risk factor for TIAs and strokes. Repeat ANA and antidsDNA tests would help confirm or exclude SLE.
Mr angiogram (to look at blood vessels of brain) can be done at the same sitting as MRI of brain and spine, and it would take an extra 10 minutes.
Yes, birth control pills as well as migraine, both increase the risk of TIA in young women.
MRI would show the area affected (that can cause hiccups).
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Great, thanks Dr. XXXXXXX I asked about MRA at my appointment but the doctor said he was happy with what they performed as of right now. So I guess we will see.
Do you think that looks like a butterfly rash in the photo? I wouldve never noticed had the ER doc not pointed it out.
Finally, I am under a lot of stress right now as I go to an international uni, am far from home, and didn't get on campus accommodation for the year coming up so I am with out a place to live, stressing about money, and exams coming up. Could the high stress be adding to all of this? Trying my best to meditate and keep stress at bay
XXXX
Do you think that looks like a butterfly rash in the photo? I wouldve never noticed had the ER doc not pointed it out.
Finally, I am under a lot of stress right now as I go to an international uni, am far from home, and didn't get on campus accommodation for the year coming up so I am with out a place to live, stressing about money, and exams coming up. Could the high stress be adding to all of this? Trying my best to meditate and keep stress at bay
XXXX
Brief Answer:
Good to note that MRI was fine.
Detailed Answer:
Thank you for getting back.
Yes, it does look like a malar butterfly rash (on the cheek bones). However, if ANA, antids DNA etc are negative, then, we can exclude lupus.
It would be good to keep stress under control, as stress does flare up symptoms.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Good to note that MRI was fine.
Detailed Answer:
Thank you for getting back.
Yes, it does look like a malar butterfly rash (on the cheek bones). However, if ANA, antids DNA etc are negative, then, we can exclude lupus.
It would be good to keep stress under control, as stress does flare up symptoms.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
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