Undiagnosed episodes of passing out

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I am an 18 year old girl who has been experiencing 2 strange episodes since I was 12. I am 5’3” and 108 lbs. I have been mostly healthy throughout my life. My medical history includes being diagnosed with PFAPA at the age of 5 and receiving a tonsillectomy which slowly improved my condition over time. I still experience symptoms of occasional auditory and tactile hallucinations, disorientation, and sight sensory overload that are heightened mainly when I have a fever, but also happen randomly occasionally. Because of this we believe I may have been misdiagnosed and actually have HYper-IgD Syndrome, but this has not been confirmed as of right now. I was diagnosed with VCD around the age of 14 which bothered me mainly when exercising. I received speech and breathing therapy for it and my condition improved. I was diagnosed with scoliosis and scapular dyskinesis around the age of 15 and received PT treatment for a year until Covid hit. I had an oxolate based kidney stone at the age of 16 and was diagnosed with hypercalciuria.

In the first type of episode, I get about a 5-10 second warning of dizziness, blackened vision, and disorientation before I pass out (on the ground, eyes closed, non-responsive). These episodes last around 2-4 minutes before I wake up and begin responding again. I remember what happens prior to passing out and afterwards. We haven’t found any possible triggers for the episodes. These episodes happen roughly every 3-4 months. My doctors believe these may just be what they’re calling traditional syncopes. I currently deal with depression and anxiety which was diagnosed at the age of 14

In the second type of episode, I do not get any warning. I slowly fall to the floor and become unresponsive; however, my eyes are open and I can occasionally stay sitting upright during the episode. They last around 3-5 minutes before I start looking around, answering questions, and moving. I do not remember what happens leading up to, furring, or after the episode. I’m only able to describe what happens based on what my mom or others around me observe when it happens. I have had these episodes happen sometimes in moments of distress and when I have fevers (although it doesn’t happen every time in these situations). Most of the time they happen randomly without any known trigger. These episodes happen roughly every 2-3 months. My doctors don’t know what to think of these types of episodes.

I have seen a cardiologist and neurologist for these episodes. The cardiologist ran an EKG which came back normal. A 48 hour holter monitor showed min 52 bpm, max 150 bpm, average 87 bpm. The only concern was 5 ventricular ectopic beats which occurred while I was sleeping. Further testing included an ECHO which came back normal. I am currently wearing a 30 day holter monitor to possibly track an episode or more unusual events. The neurologist is sending me to get an EEG and MRI of my brain but does not want to do any further testing until the cardiologist rules out any other possibilities.

We are kind of stuck at this point and I would really appreciate any possible advice on steps to take or possible diagnosis’s to look into. Thank you!

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