[19O] With cognitive impairment and headaches

Patient Description

A 19-year-old individual has been experiencing issues with speech and cognitive function for approximately two years. The symptoms include forgetting basic words, losing track of sentences, and reading words incorrectly. These issues have become more frequent and are particularly noticeable during deep conversations or tasks involving math or memory, impacting social relationships and causing anxiety. Additionally, the patient reports a painless pressure in the head, described as a squeezing sensation, primarily on the right side beneath the eye. Headaches in this area are infrequent but intense (8/10) and can last up to a week, relieved by Ibuprofen. The patient also experiences double vision, blurred vision, weakness or numbness in the arms or legs, and lightheadedness. Diagnosed with POTS and IST in January, the patient is currently taking 50mg of Metoprolol twice daily and 30mg of Diltiazem twice daily after meals. No known drug allergies. No other medications or supplements reported.

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Arora's Assessment

What might be happening

Based on the information you've provided, here are some possible explanations for your symptoms:

  • Cognitive Impairment: Given your difficulty with speech, finding words, and maintaining conversations, you might be experiencing cognitive impairment. This can be caused by various factors, including neurological conditions, mental health issues, or even side effects of medications.

  • Migraine or Cluster Headaches: The intense, localized headaches on the right side of your head, especially around the eye, could indicate migraines or cluster headaches. These types of headaches can sometimes be associated with visual disturbances like double vision or blurred vision.

  • Postural Orthostatic Tachycardia Syndrome (POTS) and Inappropriate Sinus Tachycardia (IST): These conditions can cause symptoms like lightheadedness, weakness, and cognitive difficulties, especially when standing up or during periods of physical activity.

  • Medication Side Effects: Metoprolol and Diltiazem can sometimes cause side effects such as dizziness, lightheadedness, and cognitive changes. It's important to discuss these potential side effects with your healthcare provider.

What you can do

  1. Consult a Healthcare Provider: It's crucial to speak with a healthcare provider about your symptoms. They may recommend further testing, such as imaging studies (like an MRI or CT scan) or blood tests, to rule out any underlying conditions.

  2. Monitor Your Symptoms: Keep a diary of your symptoms, noting when they occur, their severity, and any potential triggers. This information can be valuable for your healthcare provider.

  3. Manage Headaches: For your headaches, continue using Ibuprofen as needed, but be cautious about overuse. You might also try other headache management techniques, such as relaxation exercises, hydration, and avoiding known triggers.

  4. Stay Hydrated and Maintain a Healthy Diet: Proper hydration and a balanced diet can help manage symptoms of POTS and IST. Avoiding caffeine and alcohol might also be beneficial.

  5. Mental Health Support: Given the impact on your social relationships and anxiety, consider seeking support from a mental health professional. Cognitive-behavioral therapy (CBT) can be particularly helpful for managing anxiety and cognitive symptoms.

What you should look out for

  • Worsening Symptoms: If you notice a significant worsening of your symptoms, such as increased frequency or severity of headaches, more pronounced cognitive difficulties, or new neurological symptoms, seek medical attention promptly.

  • Severe Headaches: If you experience a sudden, severe headache (often described as a "thunderclap" headache), seek emergency medical care immediately.

  • Changes in Vision: Persistent or worsening double vision or blurred vision should be evaluated by a healthcare provider.

  • Severe Weakness or Numbness: If you experience sudden or severe weakness or numbness in your arms or legs, seek immediate medical attention.

Remember, while this information can be helpful, it is not a substitute for professional medical advice. Please consult with a healthcare provider to receive a formal diagnosis and appropriate treatment.

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5 mo ago


People Also Ask


What could be causing my cognitive difficulties and speech issues?

Cognitive difficulties and speech issues can be caused by various factors, including neurological conditions, mental health issues, or side effects of medications. It's important to consult a healthcare provider for a thorough evaluation.


Are my headaches related to migraines or cluster headaches?

The intense, localized headaches you are experiencing, especially around the eye, could be related to migraines or cluster headaches. These types of headaches can also cause visual disturbances like double vision or blurred vision.


How do POTS and IST affect cognitive function and cause lightheadedness?

POTS and IST can lead to symptoms like lightheadedness, weakness, and cognitive difficulties, particularly when standing up or during physical activity. These conditions affect blood flow and heart rate, which can impact brain function.


Can Metoprolol and Diltiazem cause cognitive changes or dizziness?

Yes, Metoprolol and Diltiazem can sometimes cause side effects such as dizziness, lightheadedness, and cognitive changes. It's important to discuss these potential side effects with your healthcare provider.

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