[27F] Experiencing intermittent episodes of blurred vision and faintness

Patient Description

A 27-year-old female reports infrequent episodes, occurring roughly every six months, characterized by sudden onset of blurred vision, clammy skin, hot flashes, and a sensation of impending faintness. These episodes are brief, lasting between 3 to 20 minutes, and are not provoked by any identifiable triggers. The patient has found that drinking water and consuming a candy bar can alleviate the symptoms. The patient has a history of bulimia diagnosed three years ago and is currently on Spironolactone. No known allergies or adverse reactions to medications have been reported. No other medications or chronic illnesses were mentioned.

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Arora's Assessment

Blurred vision and lightheadedness

Differential diagnosis

  • Given the sudden onset of symptoms and their resolution with candy and water, hypoglycemia (E16.2) is a likely diagnosis.
  • Other possibilities include panic attack (F41.0), vasovagal syncope (R55), and postural orthostatic tachycardia syndrome (I49.8).
  • Less likely but still possible are transient ischemic attack (G45.9), and migraine with aura (G43.1).

Plan

Order a fasting glucose test and a glucose tolerance test to evaluate for hypoglycemia. Also, consider ordering a complete blood count (CBC), electrolyte panel, and thyroid function tests to rule out other potential causes of her symptoms. If these tests are inconclusive, consider referral to a neurologist or endocrinologist for further evaluation.

Advise the patient to maintain regular meals to avoid hypoglycemia, and to continue to consume candy or a sugary drink if she feels an episode coming on. If the episodes continue or increase in frequency, consider a trial of a beta-blocker or selective serotonin reuptake inhibitor (SSRI), which can help manage symptoms of panic attacks and postural orthostatic tachycardia syndrome.

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11 mo ago

People Also Ask


What could cause sudden episodes of blurred vision and lightheadedness?

Sudden episodes of blurred vision and lightheadedness can be caused by several conditions, including hypoglycemia, panic attacks, vasovagal syncope, postural orthostatic tachycardia syndrome, transient ischemic attacks, or migraines with aura. It's important to evaluate these symptoms with a healthcare provider to determine the underlying cause.


How can hypoglycemia be managed or prevented?

Hypoglycemia can be managed by eating regular meals and snacks that include carbohydrates, monitoring blood sugar levels if necessary, and carrying quick sources of sugar, like candy or glucose tablets, to address symptoms promptly. It's also important to identify and avoid potential triggers.


What is the role of Spironolactone in managing symptoms like these?

Spironolactone is a medication primarily used as a diuretic and for conditions like hypertension and hormonal imbalances. It is not directly used to manage symptoms like blurred vision or lightheadedness, but it may have indirect effects depending on the underlying condition being treated.


When should someone see a specialist for these types of symptoms?

A specialist, such as a neurologist or endocrinologist, should be consulted if the symptoms persist despite initial management, if they increase in frequency or severity, or if initial tests do not provide a clear diagnosis. A specialist can offer more targeted testing and treatment options.


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