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Heavy sweating that led to an unexpected diagnosis

A 60-year-old man struggled with unexplained sweating episodes for three years before doctors diagnosed him ...

Posted: Jan. 15, 2019 2:50 AM
Updated: Jan. 15, 2019 2:50 AM

A 60-year-old man struggled with unexplained sweating episodes for three years before doctors diagnosed him with temporal lobe seizures, according to a case study published Monday in the Annals of Internal Medicine.

The man was otherwise healthy but had "an average of 8 discrete episodes of sweating" every 24 to 32 days, the authors said. These episodes lasted several minutes.

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He had no other symptoms, and all tests that doctors ran on him returned normal results.

Doctors saw one of these sweating episodes while the patient was on an office visit, the case study said. The patient reported that "he felt it coming on; he lowered his head into his hands and had slowed verbal responses for approximately 2 minutes."

The doctors described his sweating as "profuse" and detailed a pool of sweat left on an examination table.

The changes in the patient's responsiveness, something that "suggested a seizure," led the doctors to perform an ambulatory electroencephalography, known as an EEG, which led to his diagnosis.

An EEG is a test that records electrical activity in the brain, according to the Epilepsy Foundation. An ambulatory EEG monitors this electrical activity for a longer period of time and can be done without a hospital stay.

The patient has since been prescribed anti-seizure medication and has had only one cluster of sweating episodes in the past 18 months.

"Diagnosing seizures and epilepsy is often very challenging, in part because seizures can reproduce almost anything we are capable of experiencing or doing, depending on where in the brain a seizure starts and where in the brain a seizure spreads to," said Dr. Christopher Ransom, an assistant professor of neurology at University of Washington School of Medicine. Ransom was not involved with the patient's treatment or diagnosis.

Another hurdle when diagnosing seizures, according to Ransom, is that physicians often rely on self-reports from a patient, who could focus on only one symptom, or reporting from family and friends who have witnessed an event.

Doctors often need to test or actually witness a patient's seizure to diagnose the cause of the symptoms, Ransom said.

"I think this is a nice example of that, where they were told simply about this cyclical sweating, but it finally became apparent that it wasn't as simple as that," Ransom said.

While Ransom noted that many patients who suffer from seizures do report sweating or flushing, "it is unusual that someone simply reports that isolated symptom ... that ends up being caused by a seizure," he said.

He also noted that the reported sweating and flushing can often be "attributed to more of an aura type of event, which is still a seizure, but it's the beginning part of the seizure that will lead to more profound symptoms and alterations of behavior."

"There are not that many medical conditions that produce transient, recurrent, and highly-stereotyped neurological symptoms and epileptic seizures top that list of diagnoses to consider," Ransom said. "This case, however, produced a particular challenge because [the] patient initially only described the cyclical pattern of sweating, not neurological symptoms. It wasn't until a spell was directly observed that alterations of behavior, seen as slowed verbal responses, was recognized to accompany the episodes of intense sweating."

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