
Since April I Was Having Headaches . No Over The

Postural tachycardia syndrome may need to be ruled out
Detailed Answer:
Hello and welcome to "Ask a Doctor' services,
I carefully read your query.
There are two main things I am considering. The first has to do with the fact that you mentioned that spinal tap pressure was 18. Did the doctor explain the cause of this increased pressure? This would be very important information to obtain from your doctor.
On the other hand, if otherwise all the tests you mentioned (MRI, blood tests, heart check) are normal, very likely you get the fast heartbeat when you stand due to postural tachycardia syndrome.
This is a condition that may cause a lot of distress due to a fast heartbeat, fatigue, and dizziness with a change of position. It is not dangerous and most of the time the patient grows out of it.
To diagnose this, tilt table test is performed.
To conclude:
- it may be important to discuss with your doctor on the possible cause of the increased spinal tap pressure (if there is information from the CT or MRI that may further guide on the possible cause)
- if all the rest of the tests are normal then postural tachycardia syndrome needs to be ruled out with a tilt table test.
I hope this answers your query.
I remain at your disposal if further medical assistance is needed.
Regards,
Dr. Antoneta Zotaj
General and Family Physician


Increased B12 may need to be investigated as it may indicate the presence of other important conditions
Detailed Answer:
Hello and welcome back,
Thank you for the reply and the extra information provided. I understand your struggle with trying to keep up with your daily needs and responsibilities and not being able. POTS does explain the tiredness and the changes in heart rate while standing but as you mention it does not cover the rest of the neurological symptoms that you just mentioned. So, other than POTS you may need to be investigated on other co-existing conditions.
As for the spinal tap pressure: many neurological sites recon spinal tap pressure to be 8-15 mmHg when the patient is lying on one side or 20-30 mmHg when the patient is sitting up straight.
I checked again the recent guidelines and they say that normal spinal tap pressure may be up to 20 and in a few cases even 30 mmHg and that the spinal tap pressure needs to be evaluated on the clinical context to better determine its clinical significance.
If you have had MRI of the brain and spine (both are needed to rule out multiple sclerosis) then structural problems of the brain and spine are ruled out as the cause of the neurological symptoms you are mentioning.
As for the blood results: It is not mentioned which blood tests you have been doing but minimum tests needed would be thyroid panel to rule out thyroid problems (TSH and FT4) and basic metabolic profile (glucose, lipids, electrolytes, creatinine, ALT, AST, Bilirubin, etc), CBC with differential, ERS, etc.
Vitamin B12 may cause neuropathy with neurological symptoms if it is low. In your case, you mention it is high which is a very uncommon situation and in this case liver function is needed to be checked (ALT, AST, Bilirubin, albumin levels in the blood, coagulation tests, etc), abdominal ultrasound may identify liver structure problems (and kidney problems and other abdominal organs). Rare blood disorders may be associated with an increase in B12 as well, this is why CBC with differential is needed.
High B12 levels are not very recognized in official literature and doctors may not be very familiar with this but recent studies are starting to show that increased B12 in the blood may indicate important conditions.
I would recommend you to talk with your doctor on the high levels of B12 and needed investigations to determine the cause of this as some organ problems (liver, kidney) or even tumors may be associated with increased B12 levels according to some medical articles (the following link you may share with your doctor and discuss on it https://academic.oup.com/qjmed/article/106/6/505/0000 )
To conclude:
- POTS may justify some of your symptoms but the neurological symptoms that you just explained may need further evaluation
- spinal tap pressure may vary in individual patients, 18 mmHg may be normal according to recent guidelines
- increased B12 levels need investigations, as it may cause neurological symptoms and may indicate important organ problems (liver, kidney) or even blood disorders and tumors, thus you may need to talk with your doctor to consider the needed workup to evaluate the cause of it.
I hope this answers your query. I remain at your disposal in case further medical assistance is needed.
Regards,
Dr. Antoneta Zotaj
General and Family Physician

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