Autonomic Nervous System Disorders: When to Seek Further Testing?

Is it necessary to undergo more detailed examinations to confirm autonomic nervous system dysfunction?

Hello doctor, around the end of July this year, after having dinner and using my phone, I suddenly felt a brief disconnection in my mind for a second, followed by numbness in my hands.
I panicked, thinking I might be having a stroke.
This was accompanied by many symptoms of autonomic nervous system dysfunction.
Initially, I felt strange (like my hands weren't my own, and I was scared that I might have a serious illness).
After that, I often experienced episodes of dizziness and discomfort after meals, which would last for a long time.
Over the next few months, I also developed symptoms like frequent urination (rarely) and dry eyes (persistently).
I consulted a traditional Chinese medicine practitioner, but there was no improvement.
I then went to a large hospital for a cardiac evaluation.
The doctor ordered blood tests, which showed ALT: 39, triglycerides: 722 (possibly due to my long-term alcohol consumption), and total cholesterol: 253.
My blood pressure was normal to slightly high when I got up, but it easily spiked to high levels during activity, reaching 170 when I was anxious, and it took a long time to decrease.
After a physical examination, including auscultation, an electrocardiogram, and a chest X-ray, the doctor said my heart was fine.
I would like to ask if this really confirms that my heart is okay.
A few weeks ago, while riding my bike, I felt very cold, had numbness in my hands and upper body, and thought I was in serious trouble, so I called an ambulance to the emergency room.
The blood test results were normal, and the hospital said it was due to hyperventilation.
I then visited a psychosomatic specialist, who prescribed medication for autonomic nervous system dysfunction, including Lexapro and Xanax.
After taking them for two weeks, I felt my mood had stabilized a bit.
I also went to a neurologist for a detailed examination.
I expressed my fear of stroke and brain diseases, and he said I was overthinking.
He conducted an EEG and thyroid function tests, and the results showed I was fine, except for a slightly low T4 level: 4.4 (with TSH, T3, FT4, and Anti-TPO being normal).
The doctor suggested that my anxiety and panic might be caused by autonomic nervous system dysfunction.
However, I wonder if these tests are sufficient.
Should I consider paying out of pocket for a brain CT scan or carotid ultrasound?

Kevin, 20~29 year old female. Ask Date: 2021/12/20

Dr. Ye Qianyu reply Family Medicine

Hello! Based on your description, alcohol may lead to poor vitamin absorption, which can result in macrocytic anemia, alcoholic hepatitis, acute gastritis, and alcoholic encephalopathy, potentially causing autonomic nervous system dysfunction.
It is recommended that you regularly follow up with a hepatobiliary and gastroenterology specialist for examination and treatment.

Reply Date: 2021/12/20

More Info

It sounds like you've been experiencing a range of distressing symptoms that have understandably caused you a lot of concern. Your symptoms, including numbness, feelings of detachment, and episodes of anxiety, can indeed be associated with autonomic nervous system disorders, but they can also overlap with other medical conditions.
From what you've described, it seems that you've already undergone a comprehensive evaluation, including tests for your heart and brain function. The fact that your heart tests, including an electrocardiogram (ECG) and chest X-ray, came back normal is reassuring. Additionally, your blood tests, including thyroid function tests, have also indicated that there are no significant abnormalities, aside from a slightly low T4 level, which may be contributing to your symptoms but is not necessarily indicative of a serious condition.

The autonomic nervous system (ANS) controls many involuntary bodily functions, including heart rate, blood pressure, digestion, and respiratory rate. Disorders of the ANS can lead to symptoms like those you've described, including dizziness, heart palpitations, and gastrointestinal issues. Anxiety can exacerbate these symptoms, creating a cycle of fear and physical discomfort.

Given your history of anxiety and the recent episodes of panic, it is understandable that you might be concerned about serious conditions like stroke or other neurological disorders. However, the tests you've undergone, including the EEG and blood tests, have not indicated any acute neurological issues.
If you are still feeling uncertain or if your symptoms persist or worsen, it may be reasonable to pursue further imaging studies, such as a CT scan of the brain or a carotid ultrasound. These tests can help rule out any structural issues that might not have been detected in previous evaluations. However, it is essential to discuss this with your healthcare provider, who can help weigh the risks and benefits of additional testing based on your specific situation.

In the meantime, managing your anxiety is crucial. The medications you've been prescribed, such as Lexapro (escitalopram) and Xanax (alprazolam), can help alleviate anxiety symptoms, but they may take some time to reach their full effect. Additionally, consider integrating lifestyle changes that can support your mental health, such as regular physical activity, mindfulness practices, and a balanced diet. Reducing alcohol intake, especially given your elevated triglyceride levels, may also be beneficial for both your physical and mental health.

In summary, while your current evaluations have not indicated serious underlying conditions, your ongoing symptoms warrant close monitoring. If you continue to feel anxious or if new symptoms arise, don't hesitate to reach out to your healthcare provider for further assessment and support. It's essential to advocate for your health and ensure you feel comfortable with the care you are receiving.

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