📋 Executive Summary
Symptoms began after a May 2024 exertional vestibular event; persistent 24/7 lightheadedness became established by ~Fall 2024. Current symptoms include non-positional lightheadedness (worse upright but present seated/supine), cognitive ‘lag,’ bilateral non-pulsatile tinnitus, and orthostatic tachycardia physiology with elevated standing norepinephrine measured at 15 minutes.
Autonomic Profile
Objective testing demonstrates a hyperadrenergic pattern with tilt heart rate surge >40 bpm without orthostatic hypotension and standing norepinephrine of 630 pg/mL (measured at 15 minutes standing).
🫀 1. Autonomic & Peripheral Nerve Screen
Norepinephrine (pg/mL)
Orthostatic norepinephrine elevation (15-min stand) consistent with hyperadrenergic physiology.
Tilt Table Data
Values plotted represent approximate timepoint readings from the tilt table flowsheet; peak BP values varied across readings.
Skin Biopsy (12/4/2025)
👁️ 2. Sensory Hardware Status
Spontaneous Nystagmus
Caloric Results (Sum)
Total caloric slow-phase velocity (SCV) sum = 7°/sec.
Vision Progress
Binocular metrics improved; persistent symptoms suggest central integration component.
Clinical Observation
Vertical phoria normalized to 0Δ. Jump vergence accuracy 100%. Total caloric SCV sum 7°/sec. Binocular mechanics improved; persistent non-positional symptoms suggest evaluation of central sensory integration.
🦠 3. Immune, Gut & Vascular Axis
sCD40L (Platelet Activation Marker)
Platelet activation marker decreased over time.
Cytokines (Mar 2025 → Oct 2025)
Radiance Cytokine-14; pg/mL.
GPCRs (U/mL)
Gut Barrier (Functional Markers)
CellTrend GPCR Positive Thresholds (U/mL): AT1R ≥17, ETAR ≥17, α1 ≥11, β1 ≥15, β2 ≥14, M3 ≥10.0, M4 ≥10.7
Immune Cell Trend (cells/µL)
| Month / Year | CD3 (/µL) | CD4 (/µL) | CD8 (/µL) | NK (/µL) | CD19 (/µL) |
|---|---|---|---|---|---|
| Mar 2025* | 1618 | 1234 | 327 | — | — |
| May 2025 | 1728 | 1334 | 409 | — | 360 |
| Aug 2025 | 1302 | 960 | 319 | 274 | 291 |
| Oct 2025 | 1083 | 813 | 275 | 224 | — |
| Jan 2026 | 1205 | 923 | 292 | 230 | 241 |
| Ref Range | 622–2402 | 359–1519 | 109–897 | 24–406 | 12–645 |
*April 2025 COVID reinfection noted. NK and CD19 data missing for Mar 2025.
Takeaway Counts declined after Apr 2025 reinfection (nadir Oct 2025) with partial recovery by Jan 2026.
🧠 4. Neurologic & Metabolic Axis
ASL Perfusion Analysis
Relative perfusion pattern based on ASL radiology interpretation.
Radiologist Note (ASL MRI)
"ASL map shows patchy hypoperfusion frontal toward the vertex, deep temporal and occipital lobes bilaterally, with somewhat diminished basal ganglia activity. No focal infarct or structural lesion reported."
MitoSwab Summary
High Citrate Synthase (306%) suggests compensatory mitochondrial biogenesis, with relative reduction in Complex I activity (50%). Functional assay variance; not diagnostic of primary mitochondrial disease.