A 15 June 2008 New York Times Magazine "Diagnosis" article describes "Strange Spells":

The boy was sitting in his 10th-grade math class at a high school in Atlanta when he had his first attack. He does not remember what happened, but his classmates noticed that he seemed to be in some sort of trance. He stared straight ahead, eyes unfocused. His lips moved, but no words came out — just a few jumbled syllables. His face looked strangely lopsided.

As the school nurse hurried into the classroom, her first thought was that — as unlikely as it seemed — this 15-year-old boy was having a stroke. But as she examined the boy, he began to improve. The color seeped back into his face, and the asymmetry disappeared. His pulse and blood pressure were normal. By the time the boy’s mother got to the school, he was back to his usual self.

He got a detailed workup, with no predisposition to stroke found.

And for six months nothing happened. Then in July, the boy had a second attack, and in September, a third. With each attack, the boy was lightheaded and dazed, and there was a new symptom — in addition to the facial droop, his right hand and sometimes his right leg would shake.

And yet over the course of that fall, the attacks became more frequent. Once a week, sometimes twice, his mother would get a call from school saying that her son was being sent to the hospital. One neurologist thought these might be seizures and started the teenager on an antiseizure medication. But the attacks kept coming.

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They saw many doctors, and finally reached Dr. Rebecca Ichord:

Ichord went through each of the attacks with the teenager and his mother, she began to notice a pattern. “Were you always sitting down when these spells came on?” she asked. The patient thought for a moment. Yes, at the time of each of these episodes he had been sitting for a long time. They never occurred when he was active. It was the answer she was hoping for. “I think you have something called postural orthostatic tachycardia syndrome,” she told the boy.

She checked his pulse and his blood pressure. Both were normal. Then she had him sit up and measured his pulse and blood pressure again. Normally blood pressure doesn’t change much and heart rate increases slightly as the body tries to get all the blood from the lower body, where it is pooled, to the rest of the body, which now needs more blood. In this patient, though his blood pressure remained normal, his heart began to race as his body tried to force the blood from his legs all the way up to his brain. Based on this test, Ichord thought it was quite likely that the teenager had POTS. She ordered a study, which confirmed her diagnosis.

“What’s amazing to me,” the patient told me recently, “is that I went to dozens of doctors, had hundreds of tests, had gallons of blood taken, and Dr. Ichord made this diagnosis with just one question and a blood-pressure cuff. I couldn’t believe it.” The difference was that, unlike the other doctors who had seen this patient, Ichord knew what she was looking for.

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