camoman1234 Posted June 21, 2018 Share Posted June 21, 2018 What can anyone tell me about their experiences with THAD? I have a mid 40's male with 2 events of unexplained syncope (over the last 1 1/2 years), has been seen at ER both times, negative workup including brain mri, echo, ekg, CTA PE, AAA and Carotid U/S, lab work WNL except borderline hyperlipidemia, pharmacogenetic testing pending. Both syncope episodes at night (fixing to get ready for bed or was already in bed), wife states he was posturing, growling, and did not know what happen after the 2 minute event, no seizure activity. He is a non-smoker, non-drinker, no drugs, etc. Very healthy, clean, nice guy. Diet is overall fine, could work on it, but overall they eat healthy to American standards. I get a U/S of liver, possible 4.8 cm mass, "probably hemangioma" needs CT per radiology. I got CT w/ and w/o of liver, comes back THAD vs Hemangioma. I am waiting to hear back from GI today for a consult as this patient is moving across the country in ~1 month. I am just looking for more information on THAD and if anyone has experience with this. Link to comment Share on other sites More sharing options...
Moderator ventana Posted June 21, 2018 Moderator Share Posted June 21, 2018 needs a sleep deprived EEG also trial of AED for presumed sz d/o (EEG does not rule it out) once liver issue resolved.... THAD - no idea Link to comment Share on other sites More sharing options...
camoman1234 Posted June 21, 2018 Author Share Posted June 21, 2018 1 hour ago, ventana said: needs a sleep deprived EEG also trial of AED for presumed sz d/o (EEG does not rule it out) once liver issue resolved.... THAD - no idea AED for 2 episodes in his entire life time, 15 months apart? Please help me understand your thought process? Are there guidelines for this. Thank you for the sleep deprived EEG recommendation, I did not have that on my list, will add! Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted June 21, 2018 Share Posted June 21, 2018 Prodromal or not? Recollection of pre-event settings? Sounds like me (both occurrences at Costco w/ one frank syncope). I knew what was occurring (altered orientation) but had visual disorientation specifically before syncopal event x~1”. Treated for partial complex sz. after negative w/u. Random seizure incidence in lifetime is ~10% for general population. Link to comment Share on other sites More sharing options...
camoman1234 Posted June 21, 2018 Author Share Posted June 21, 2018 19 minutes ago, GetMeOuttaThisMess said: Prodromal or not? Recollection of pre-event settings? Sounds like me (both occurrences at Costco w/ one frank syncope). I knew what was occurring (altered orientation) but had visual disorientation specifically before syncopal event x~1”. Treated for partial complex sz. after negative w/u. Random seizure incidence in lifetime is ~10% for general population. Nothing he states would point me to a prodromal S/S. ROS negative except fatigue (does have newly diagnoses of hypogonadism). Has lots of stress per his report. I did not know that about random seizure incidence in a lifetime, Thank you! Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted June 22, 2018 Share Posted June 22, 2018 3 hours ago, camoman1234 said: Nothing he states would point me to a prodromal S/S. ROS negative except fatigue (does have newly diagnoses of hypogonadism). Has lots of stress per his report. I did not know that about random seizure incidence in a lifetime, Thank you! A lot more common than people think. Link to comment Share on other sites More sharing options...
Randito Posted June 22, 2018 Share Posted June 22, 2018 If I recall correctly from my time in hepatology. A THAD is usually seen as a triangular shaped area of arterial enhancement on CT scan that is often confused for HCC. To radiographically evaluate for HCC, you need a 4 phase CT. HCC will show arterial enhancement and delayed phase washout. A THAD has arterial enhancement but no washout. THAD is a benign finding. I don’t think there is any relation with your patient’s syncopal events. Link to comment Share on other sites More sharing options...
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