14F with abrupt cognitive decline, headaches, dizziness, and memory impairment after passing out; normal MRI/CT, positive EBV, low folate & vitamin D
**Age:** 14 **Sex:** Female **Height:** 5'2" **Weight:** 145 lbs **Race:** White **Primary complaint:** Sudden cognitive decline and neurological symptoms **Duration:** \~4 months **Medical history:** ADHD. Mild childhood sleep apnea resolved after tonsillectomy/adenoidectomy. Otherwise healthy. **Medications:** Melatonin nightly only. Recently added Vitamin D and Folate per doctors suggestion (see below) **No alcohol, tobacco, or recreational drug use.**
I'm hoping for ideas on what diagnoses or testing we should discuss with her doctors.
My daughter was a healthy, straight-A student and competitive basketball/soccer player. She had no learning difficulties beyond ADHD and functioned very well academically.
About 2 months ago she woke around 6 AM with severe abdominal pain. She appeared confused/almost sleepwalking, had a large bowel movement (not diarrhea), then fainted. Since that day she has never returned to normal.
Her biggest change is cognitive. She went from earning straight A's to struggling to remember what she just read and being unable to tolerate full school days.
**Current symptoms:**
* Daily headaches (sometimes 8/10, described as burning or like being punched in the head) * Lightheadedness/dizziness * Balance problems/"wobbly" feeling * Significant short-term memory problems * Difficulty concentrating * Decline in school performance * Sensitivity to light and sound * Intermittent numb/"asleep" or sharp pains sensation across her body lasting about 2 minutes * Drops objects more often than before
**Testing so far:**
* Brain CT: Normal * Brain MRI with and without contrast: Normal * EKG: Normal * Echocardiogram: Normal * Orthostatic vitals: Normal * Lyme: Negative * ANA: Normal
**Abnormal labs:**
* Positive Epstein-Barr virus (EBV) testing - shows positive but not a recent infection * Low folate (5.5 ng/mL - said 7.8 was normal) * Slightly Low vitamin D (19 vs 20) * Slightly Low mean platelet volume (MPV) (9.1 with 9.5 being normal) * Vitamin B12: 486 (normal)
Her neurologist has evaluated her, but we still don't have an explanation for the abrupt change. We have ongoing visits with them but they are baffled. We're also in therapy to help with the anxiety this has caused. Any suggestions on what we can do, where we can go, what tests to run to help her get back to being herself and enjoying sports, school, and life in general. Thank you so much.