Panic attack/PTSD/seizures

bigbaldguy

bigbaldguy

Former medic seven years 911 service in houston
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Is it possible for a severe panic attack caused by PTSD to result in loss of consciousness and seizure? Has anyone seen this in the field? Recently had a case where patient appeared to be having a massive panic attack. Patient would pass out then seize then rouse then it would repeat. Could this be caused by hyperventilation. I'm 99.9 percent certain this individual was not faking the loss of consciousness or seizures.
 
Panic Attacks

You bet they can! I've actually had one. It's different for everyone but it is an involuntary activation of the sympathetic nervous system and can cause profound dizziness, shaking, tachypnea, sweating, tachycardia, feeling of impending doom, etc. etc.
 
Anytime you recover from vasovagal or hypervent syncope you can do Funky Chicken.

There is also the possibility of a psychological component.
 
After a similar situation the explination I got was "kind of".

The MD said that since my patient didn't have a notable postictal period that most likely the pt lost consciousness from the hyperventilation and was having significant carpal-pedal spasms that were mimicking seizure like activity.
 
Aidey said:
After a similar situation the explination I got was "kind of".

The MD said that since my patient didn't have a notable postictal period that most likely the pt lost consciousness from the hyperventilation and was having significant carpal-pedal spasms that were mimicking seizure like activity.
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My mother had a pulmonary embolism and had all those symptoms. The medic said it was probably just a panic attack then the doctor tested and confirmed the embolism.
 
Mine pt was a 12yo female with a psych history. Her CO2 got down to 7 right before the last time she passed out. Resp rate went way down, CO2 came up, she woke up. With some serious coaching I was able to keep her resp rate at a decent level and she stayed conscious after that, with a CO2 in the mid 20s I think.
 
Google 'conversion disorder'. I'm not making a dx of your pt, just suggesting it as a possibility.

These are complex patients that are often difficult to manage even at the highest levels and it is a class of pts that are not at all well understood. The best treatment from us is the rest and reassurance we offer most pts and to quell the underlying judgement that often surrounds the more (oft named) dubious psychiatric pts.
 
bigbaldguy said:
Is it possible for a severe panic attack caused by PTSD to result in loss of consciousness and seizure? Has anyone seen this in the field? Recently had a case where patient appeared to be having a massive panic attack. Patient would pass out then seize then rouse then it would repeat. Could this be caused by hyperventilation. I'm 99.9 percent certain this individual was not faking the loss of consciousness or seizures.
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You need to be careful with this.

Sometimes providers see hyperventilation, one of the family members may mention anxiety and everybody runs with panic attack when it actually can be something more sinister, these people need to be assessed thoroughly.

Sounds complicated, maybe more them one thing going on, what was her history like?
 
bigbaldguy said:
Is it possible for a severe panic attack caused by PTSD to result in loss of consciousness and seizure? Has anyone seen this in the field? Recently had a case where patient appeared to be having a massive panic attack. Patient would pass out then seize then rouse then it would repeat. Could this be caused by hyperventilation. I'm 99.9 percent certain this individual was not faking the loss of consciousness or seizures.
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Yes, severe hyperventilation can result in loss of consciousness. Remember, hypocapnia (which is many times the result of hyperventilation) causes cerebral vasoconstriction, which can in turn cause a loss of consciousness.
 
medichopeful said:
Yes, severe hyperventilation can result in loss of consciousness. Remember, hypocapnia (which is many times the result of hyperventilation) causes cerebral vasoconstriction, which can in turn cause a loss of consciousness.
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Exactly what Brown was going to say.
 
Male adult patient, confirmed history of anxiety related to a traumatic event.
Pulse variable
Resp 75 (hard to tell on this one)
BP 140/90

One additional note, something I forgot about till I sat down and thought about it. Every time the patient went unconscious his heart rate would drop 30+ beats a minute even during seizure, and even when he was awake it was all over the place from 90 to 160's. I initially though this was a drug issue but my ICP took over the questioning and I started talking to witnesses. From, the info I got from witnesses it is very unlikely this was a drug issue.
 
What was the rest of this blokes presentation like? Was he anxious? hyperactive? flushed? sweaty? Did you get a temperature or a GCS? What was he doing before this "panic attack" happened? What meds was he on?

Brown is thinking you are probably right but Brown's differentials also include something metabolic or neurogenic.
 
There is some correlation between panic attacks and focal seizure activity, but I need a nap and my brain is mush, maybe someone else could chime in I don't believe its common, but it does happen on occasion.
 
MrBrown said:
What was the rest of this blokes presentation like? Was he anxious? hyperactive? flushed? sweaty? Did you get a temperature or a GCS? What was he doing before this "panic attack" happened? What meds was he on?

Brown is thinking you are probably right but Brown's differentials also include something metabolic or neurogenic.
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Patient broke down in a stairwell in a building. No one else was around and he was found by a security guard. Might have been there for a bit. Very pale, clammy, eyes were glazed, patient was only vaguely responsive to verbal instructions while conscious. His over all appearance was that of someone having a panic attack plus the added symptoms of loss of consciousness and seizure. When he did come around he did not appear altered other than being very anxious. He also complained at one point of his chest hurting but I think it was from the hyperventilation as it went away when we got his breathing to slow a bit. He definitely wasn't hyperactive. Temp was normal, GCS was also normal, sinus rhythm was normal other than the wild swings in heart rate. I spoke with several people on scene and at the hospital that know the kid well and they all said it was unlikely he was using any drugs or at least any drugs that would cause this kind of reaction. Patient did have a history of these attacks but as near as I could tell this was the worst one yet. There was a major event that had just occurred involving his family life that may have triggered this. I won't get into details on the cause for his PTSD but lets just say he had a really really bad childhood. My main concern is that if I had been on my own I would have treated this as a drug issue, luckily my ICP spotted it as a true panic attack and reined me in before I started giving the kid 20 questions on what drugs he had taken and made the situation worse.
 
Absence of post-ictal state is indicative of.....

......anyone....?:unsure:
 
mycrofft said:
......anyone....?:unsure:
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Psychogenic non-epileptic seizures. There are also several forms of epileptic seizures that don't generally include a postictical state but with the information provided, I don't think that's the problem the patient was having.
 
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Zodiac said:
Psychogenic non-epileptic seizures.
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Just spent an hour reading up on this and yes it does fit very well with what was happening to the patient. It also fits with the patients history.

Thank you for your help on this one :)
 
When you hear hooves, look for horses and not zebras. History of anxiety and hyperventilation that passes out, wakes up and does it again is an anxiety attack. It's psychological. Remove from stressful environment and enhance calm.
 
Anxiety is a diagnosis of exclusion and SHOULD NOT be made in the field! My Gestalt says that many patients are having "Panic Attacks", however you ABSOLUTELY can not diagnosis this in the field. These patients get a full work up and transported for further evaluation of whatever symptoms they are having.

Signs/Symptoms of "Anxiety"- Shortness of breath, anxiousness, hyperventilation, hypocapnea, dyspnea, "sharp" chest pain with sudden onset, Tachycardia, clear lung sounds. dizziness/syncope. Clammy or diaphoretic skin.

Signs/Symptoms of Pulmonary Embolism- Shortness of breath, anxiousness, hyperventilation, hypocapnea, dyspnea, "sharp" chest pain with sudden onset, Tachycardia, clear lung sounds. Dizziness/syncope. Clammy or diarphoretic skin.

Understand?
 
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