In medical practice sometimes we see patients that have symptoms but we cannot find the reason for that and then we do the work up and no etiology is found . Sometimes the cause is obvious but may not be easy to be acceptable for the patient. e.g. shortness of breath in someone who is obese and has not done any exercise in several tears . I used to do a pulmonary stress tests that actually had a diagnosis of 'deconditioning'. But sometimes the symptoms are unusual and can be missed as the presentation is not typical. But I often say a YOUR EYES CAN'T SEE WHAT YOUR MIND DOES NNOT THINK.' That brings to my story for today.
I was asked to see a patient who was a nurse . She had some episodes of dizziness and some vertigo . I am not sure exactly what was it but while working she had to sit down and then she would get better in short time . She worked in ICU. One episode was rather severe and she was admitted in ICU itself . The neurologist and cardiologist saw her and did tests and the CT scan of the brain was ok The cardiac work up was also normal. So there was no cause for her symptom found out. This story is from may be 25 years ago.The admitting physician called me to see her . I am not sure why me as I am a lung specialist and there was no lung problem as such. The day that she was to be discharged she had an episode of severe vertigo and so the discharge was held and I was called .I was going to see her and I got a call from the Medical director of her insurance. He was ex oncologist and he knew me . He called me and stated that 'See what you can do - I don't think anything is going on, Get her out quickly.'
I went to see her in ICU. She was 44 years old female who had no major medical issues . She had some childhood trauma - mistreatment by her father. She had been diagnosed to have mild high blood pressure and was on medications and all the readings were normal. I talked to the nurse taking care of her . When I went in the ICU , the nurse told me that that morning she was fine and then she had the 'attack' where she was having severe vertigo and felt dizzy and was in bed and did not want to move even in bed as it made her symptoms worse .I went in her room and she was calm and lying in bed comfortably. I looked at the monitor. Her heart rate was 55 and her blood pressure was normal . What struck was her respiratory rate was 4. Normal heart rate is 70 to 100. But I have seen heart rate of 55 in normal people . But normal respiratory rate is 12 and her rate was 4 . THIS WAS VERY UNUSUAL . I have known people who can go in mediation and drop heart rate but never seen low respiratory rate. Due to stimulation of respiratory centers by lack of oxygen and build up of carbon dioxide one can not reduce respiratory rate. I spoke to her and there was nothing new and her examination was normal. I did not know what to make of her low respiratory rate . She did have some headaches. AND IT STRUCK ME. Could she have something to do with centers for respiration-like what used to be called VERTEBRO BASILER MIGRAIN -now called Migraine with brainstem aura. The neurologist had seen her and told her that there was nothing he can do. I decided to call Mayo Clinic. I got the number from case manager and called Mayo clinic neurology department. I am not sure how this can happen but I got to speak to head of the neurology. I explained him the presentation and my thought process. He agreed with my thought process and told me to do new EEG.I started her on vasodilator and her symptoms improved and she was discharged home . Her vertigo and dizziness had gone down to almost zero.
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