Following would be the diagnostic considerations;
1) Transient neurological attacks (TNAs). TNAs are defined as episodes of sudden onset of neurological symptoms that completely resolve. These are classified as focal and non focal. A nonfocal TNA is a temporary event of diffuse, non localizing, cerebral symptoms that set in suddenly and resolve quickly. Symptoms of nonfocal TNAs may be altered consciousness, dizziness, visual abnormality, abnormal sensation, weakness, or generalized feelings of unwell with a clinical suspicion for neurological disease. TNAs are considered to be benign.
3) Migraine or migraine variants
Following are the investigations for ascertaining the cause of your episodes;
1) MRI with gadolinium contrast
2) Magnetic resonance angiography (MRA)
3) Tilt table test
4) Carotid sinus massage
5) Electroencephalography (EEG)
6) Stress cardiac test
7) Total creatine kinase (CK) and heart enzymes; done immediately after the episode and would tell about the abnormal brain or heart activity which caused the event.
8) Following also may be done after the episode; blood electrolytes and blood glucose.
Following are the causes which too may be responsible and can be ascertained by the above investigations;
1) bradyarrhythmias; this is sudden slowing of the heart. it is mainly due to sinus and atrial node dysfunctions. Sick sinus syndrome is a prototype of these arrhythmias. 24 hour Holter monitoring, echocardiography etc are the investigations done for it.
2) neurocardiogenic mechanisms; this is fall of the blood pressure suddenly due to a sudden sympathetic failure (failure of the autonomic nervous system). It can be accompanied by flushing, nausea, and sweating.
3) carotid hypersensitivity syndrome is an exaggerated response to carotid sinus stimulation.
4) orthostatic hypotension is due to failure of autonomic nervous system and related heart regulatory mechanisms.
Please feel free for your follow up questions.
I would be happy to assist you further, if you need any more information.
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