Dizziness and Fainting: When to See a Neurologist

Cold sweats and fainting?

Hello Dr.
Jiang, I would like to inquire about the following: Recently, I fainted while on the subway.
I had already eaten breakfast before taking the subway, and I was standing at the time.
The symptoms I experienced before fainting included dizziness, cold sweats, nausea, back pain, and overall weakness, after which I lost consciousness.
The dizziness felt relatively mild in comparison.
I also had a fainting episode two months ago, during which I did not completely lose consciousness; I felt very uncomfortable and could not stand.
After falling, someone helped me, but I felt like I couldn't stand up, my vision went dark, and I really wanted to lie down and felt nauseous.
I would like to ask if, given these circumstances, it is appropriate for me to see a neurologist, or should I consult a different specialty for further examination? Thank you, Dr.
Jiang.

Ying, 20~29 year old female. Ask Date: 2018/07/01

Dr. Jiang Junyi reply Neurology

Based on your description, the symptoms you mentioned are more likely caused by syncope.
Loss of consciousness can occur when cerebral blood flow drops below 30 mL per minute, typically due to autonomic dysfunction leading to rapid drops in blood pressure or vasoconstriction, resulting in reduced cerebral blood flow and subsequent hypoxia.
Syncope is more likely to occur when a person is standing, as this position results in the least cerebral blood flow and increased cardiac output.
However, when cerebral blood flow decreases, the body may not be able to respond quickly enough, leading to syncope.
The likelihood of syncope is lower when sitting and almost nonexistent when lying down.
Prior to losing consciousness, individuals may experience prodromal symptoms such as nausea, yawning, dizziness, a feeling of warmth, sweating, and cold extremities.
After losing consciousness, signs may include pallor, cold skin, muscle relaxation, weak pulse, and lying still.
If you frequently experience these symptoms, do not force yourself to stand; instead, quickly sit down or squat to avoid the risk of falling and sustaining a head injury, which could be fatal.
It is advisable to discuss potential examinations and treatments with a neurologist or cardiologist, which may include a 24-hour Holter monitor to rule out arrhythmias.
Wishing you good health and peace.
Dr.
Jiang from Taoyuan Medical Center cares about you.

Reply Date: 2018/07/01

More Info

Dizziness and fainting can be concerning symptoms that may indicate underlying health issues. Based on your description, it is indeed appropriate to consult a neurologist, as these symptoms can be related to neurological conditions. However, it is also essential to consider other potential causes, which may involve different specialties.

When you experience dizziness, cold sweats, nausea, back pain, and generalized weakness, it raises the possibility of several conditions. These symptoms could be indicative of a transient ischemic attack (TIA), orthostatic hypotension, or even a vasovagal syncope, which is a common cause of fainting. A TIA, often referred to as a "mini-stroke," can present with dizziness and fainting, and it is crucial to rule this out, especially if you have risk factors such as hypertension, diabetes, or a family history of cardiovascular disease.

Your previous episodes of fainting, particularly if they were accompanied by similar symptoms, warrant further investigation. The fact that you experienced partial loss of consciousness and visual disturbances (seeing black) suggests that your brain may not be receiving adequate blood flow temporarily. This could be due to a drop in blood pressure when standing (orthostatic hypotension) or other cardiovascular issues.
A neurologist can perform a thorough evaluation, which may include a neurological examination, imaging studies like an MRI or CT scan of the brain, and possibly an electroencephalogram (EEG) to assess brain activity. They may also evaluate for conditions such as migraines, seizure disorders, or other neurological conditions that could explain your symptoms.

In addition to seeing a neurologist, it may also be beneficial to consult with a cardiologist. They can perform tests such as an electrocardiogram (ECG) or echocardiogram to assess your heart's function and rule out any cardiac causes of your symptoms. Sometimes, fainting can be related to arrhythmias or structural heart problems that might not be immediately apparent.

Furthermore, consider lifestyle factors that could contribute to your symptoms. Dehydration, low blood sugar, or even anxiety can lead to dizziness and fainting spells. Ensure you are eating balanced meals, staying hydrated, and managing stress effectively.
In summary, your symptoms are significant enough to warrant a visit to a neurologist, and it may also be prudent to see a cardiologist. Both specialists can work together to determine the underlying cause of your symptoms and develop an appropriate treatment plan. If your symptoms worsen or you experience additional concerning symptoms, such as chest pain or prolonged loss of consciousness, seek immediate medical attention.

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