I was seen in A&E 4 days ago as I had become unwell at work. The doctor said I may have had a 'mini stroke' and he would arrange for me to be seen in out patients. I went home and within an hour had a phone call asking me to attend clinic the next morning. I went and was seen by a consultant physician who, after some questioning and prodding sent me for an immediate CT scan. She got the results there and then and said the scan was ok but that I had had a full stroke the day before and that it had happened in the back of the brain. How can she say this if the scan was ok? I have some numbness around the lip and a slight droop of the lip but that is all. I declined to be admitted for a lumbar puncture but have to have further tests including MRI on Monday.
I feel a bit overwhelmed as I don't feel ill, just a bit 'wooly'....does this sound more like a mini stroke or something like Bells Palsy rather than a stroke. I ask because of the medications she wants me to take. Nadia; I am already on statins 'cos of familial high cholesterol. Physician wants me to take Perstantin, Aspirin and an ACE inhibitor. She was querying haemorrhage after violent, sudden headache a week before this but felt it was more likely a 'blockage' stroke. symptoms can be a stronger indication of a stroke rather than the CT brain scan itself. in fact it has been said that a stroke does not show up straight away on a brain scan. considering you have numbness around your lips and a droop it definitely sounds like you had a stroke. the MRI should give more indepth details. I wish you the best with your recovery. Goodness before something else
happens, have it monitored often.
Ther doc might be offering
short term emergency ways
to bring down the risk of recurrence.
Some strokes are horribly more debilitating.
A chollestral reducercould help lower coagulation
if you have aterial clogging. She probably saw an area of damage in the brain. The scan could be ok because no further damage was being done, by a bleed for example. My daughter had a cva and by the time she was scanned the clot had passed, but the damage was there. Take the meds, the next time would certainly be worse. SHREYA has kindly given you all the details in length. Its very useful. Take care of yourself allthe best. You will be in top form soon, not to worry. Asprin should help to thin the blood and take away the blood clots that are the main cause of all your troubles. Be active, do exercises, eat fresh fruit and veg and lots of water and do YOGA every day. hi, the tissue damaged by a stroke has to die first before it shows properly on a scan, usually a week or more, the lower down the back of the brain it is, the harder it is to see. Yes it sounds like a full blown stroke to me. The doctor could diagnose the CVA fron clinical signs ie blood pressure, droop, numbness......
Then after, the CT is performed to decipher whether or not it was a stroke, if so which category a haemmorage or an infarct. Yours seems to have been an infarct.
Depending on the position of the infarce has a bearing on recovery and the likelihood of it happening again.
I would imagine that theCT was inconclusive thats the reason they want to do an MRI. Really you should have gone ahead with the LP. It may be that the Physician is querying something different than a CVA which is possible, though more likely to have been an infarct by what you are saying.
PS an infarct is when a clot of plaque or a blood clot blocks off a blood vessel, cutting off the blood supply momentarily to the brain.
You may well be going for a Carotid doppler (a scan of the arteries in the neck) to see if theres any stenosis if so they may offer you an operation to rectify this and to help prevent any further CVAs. Has the physician put you on Perstantin 200mgs (Dipyridamole) and asprin 75mgs? oh and also a statin like atorvastatin 20mgs or simvastatin 40mgs ? Doyou mean "Persantine"?
Dipyridamole (generic name) Persantine (brand name) is used with other drugs to reduce the risk of blood clots after heart valve replacement. It works by preventing excessive blood clotting.
ACE inhibitors: ACE stands for angiotensin converting enzyme. Levels of angiotensin, a chemical which narrows blood vessels, are restricted by the drug, causing the arteries to dilate and leading to a fall in blood pressure.
Types of ACE inhibitor include enalaparil, captopril and lisinopril.
Side-effects include a fall in blood pressure, especially when combined with diuretics for the first time.
A transient ischemic attack (TIA) is focal brain ischemia producing sudden neurologic deficits that last < 1 h. Diagnosis is clinical. Carotid endarterectomy, antiplatelet drugs, and warfarin decrease risk of stroke after certain types of TIA.
Exams and Tests:
Because symptoms and signs may have completely disappeared by the time one gets to the hospital, A diagnosis of a TIA may be made on a person's medical history alone.
A physical examination should include a neurological exam, which may be abnormal during an episode but normal after the episode has passed.
Blood pressure may be high. The doctor will use a stethoscope to listen to your heart and arteries. An abnormal sound called a bruit may be heard when listening to the carotid artery in the neck or other artery. A bruit is caused by irregular blood flow.
Tests will be done to rule out a stroke or other disorder that may cause the symptoms. Tests to diagnose a TIA may include:
* CBC and PT tests to rule out a blood disorder
* Head CT scan or cranial MRI
* Carotid duplex (ultrasound)
* Echocardiogram
* Cerebral arteriogram
Additional tests and procedures may include:
* Blood glucose
* Blood chemistry
* Serum lipids
* ESR (Sedimentation rate)
* Tests for syphilis
* ECG
* Chest x-ray
Your doctor may use these tests to check for hypertension, heart disease, diabetes, high blood lipids, vasculitis, and peripheral vascular disease. Because early treatment can help limit loss of function and sensation, everyone should know what the early symptoms of stroke are. People who have any of these symptoms should see a doctor immediately, even if the symptom goes away quickly.
Most strokes, whether ischemic or hemorrhagic, typically cause one or more of the following symptoms:
Sudden weakness or paralysis on one side of the body (for example, half of the face, one arm or leg, or all of one side)
Sudden loss of sensation or abnormal sensations on one side of the body
Sudden difficulty speaking, sometimes with slurred speech
Sudden confusion, with difficulty understanding speech
Sudden dimness, blurring, or loss of vision, particularly in one eye
Sudden dizziness or loss of balance and coordination, leading to falls
Symptoms of a transient ischemic attack are the same, but they usually disappear within minutes and rarely last more than 1 hour.
Why Strokes Affect Only One Side of the Body ?
Strokes usually damage only one side of the brain. Because nerves in the brain cross over to the other side of the body, symptoms appear on the side of the body opposite the damaged side of the brain.
Symptoms of a hemorrhagic stroke may also include the following:
Sudden severe headache
Nausea and vomiting
Temporary or persistent loss of consciousness
Very high blood pressure
Other symptoms that may occur early include problems with memory, thinking, attention, or learning. People may be unable to recognize parts of the body and may be unaware of the stroke's effects. The peripheral field of vision may be reduced, and hearing may be partially lost. Dizziness and vertigo may develop or persist. Control of bowel or bladder function may be lost.
Later symptoms may include stiffening and spasms of the muscles (spasticity) and inability to control emotions. A stroke can cause depression, or people may feel depressed because of the stroke.
In most people who have had an ischemic stroke, loss of function is usually greatest immediately after the stroke occurs. However, in about 15 to 20%, the stroke is progressive, causing greatest loss of function after a day or two. In people who have had a hemorrhagic stroke, function usually is lost progressively over minutes to hours.
Over days to months, some function is usually regained because even though some brain cells die, others are only stressed and may recover. Also, certain areas of the brain can sometimes switch to the functions previously done by the damaged part鈥攁 characteristic called plasticity. However, the early effects of a stroke, including paralysis, can become permanent. Muscles that are not used usually become permanently spastic and stiff, and painful muscle spasms may occur. Walking, swallowing, physically saying words clearly, and doing daily activities may remain difficult. Various problems with memory, thinking, attention, learning, or controlling emotions may persist. Depression, impairments in hearing or vision, or vertigo may be continuing problems. Control of bowel or bladder function may be permanently impaired.
Complications:
When a stroke is severe, the brain swells, increasing pressure within the skull. Increased pressure can damage the brain directly or indirectly by forcing the brain downward in the skull. The brain may be forced through the rigid structures that separate the brain into compartments, resulting in a serious problem called herniation (see Head Injuries:Introduction). The pressure affects the respiratory center in the lower part of the brain stem and can cause irregular breathing, loss of consciousness, coma, and death.
The symptoms caused by a stroke can lead to other problems. If swallowing is difficult, people may inhale food, fluids, or other particles from the mouth. Such inhalation (called aspiration) can cause aspiration pneumonia, which may be serious. Difficulty swallowing can also interfere with eating, resulting in undernutrition and dehydration. Not being able to move can result in pressure sores, muscle loss, and the formation of blood clots in deep veins of the legs and groin (deep vein thrombosis). Clots can break off, travel through the bloodstream, and block an artery to a lung (pulmonary embolism). If bladder control is impaired, urinary tract infections are more likely to develop.
Diagnosis:
Symptoms suggest the diagnosis, but tests are needed to help doctors determine the following:
Whether stroke has occurred
Whether it is ischemic or hemorrhagic
Whether immediate treatment is required
Computed tomography (CT) or magnetic resonance imaging (MRI) of the brain is done. These tests can detect most hemorrhagic strokes, except for some subarachnoid hemorrhages. These tests can also detect many ischemic strokes but sometimes not until several hours after symptoms appear. The blood sugar level is measured immediately because a low blood sugar level (hypoglycemia) can cause symptoms similar to those of stroke.
Doctors evaluate people who have had a stroke for problems that can contribute to or cause a stroke, such as infection, a low blood oxygen level, and dehydration, Tests are done as needed. People are asked about depression. The ability to swallow is evaluated, sometimes with x-rays taken after a radiopaque dye such as barium is swallowed. Depending on the type of stroke, more tests are done to identify the cause.
Prognosis:
Certain factors suggest that the outcome of a stroke is likely to be poor. Strokes that cause unconsciousness or that affect a large part of the left side of the brain (which is responsible for language) may be particularly grave.
In adults who have had an ischemic stroke, problems that remain after 6 months are likely to be permanent, but children continue to improve slowly for many months. Older people fare less well than younger people. For people who already have other serious disorders (such as dementia), recovery is more limited.
If a hemorrhagic stroke is not massive and pressure within the brain is not very high, the outcome is likely to be better after than that after an ischemic stroke. Blood (in a hemorrhagic stroke) does not damage brain tissue as much as an inadequate supply of oxygen (in an ischemic stroke) does.
Prevention:
Preventing strokes is preferable to treating them. The main strategy for preventing a first stroke is managing the major risk factors. High blood pressure (see High Blood Pressure) and diabetes (see Diabetes Mellitus (DM))should be controlled. Cholesterol levels should be measured and, if high, lowered to reduce the risk of atherosclerosis (see Cholesterol Disorders: Treatment). Smoking and use of amphetamines or cocaine should be stopped, and alcohol should be limited to no more than 2 drinks a day. Exercising regularly and, if overweight, losing weight help people control high blood pressure, diabetes, and high cholesterol levels. Having regular checkups enables a doctor to identify risk factors for stroke so that they can be managed quickly.
If people have had an ischemic stroke, taking an antiplatelet drug can reduce the risk of another ischemic stroke. Antiplatelet drugs make platelets less likely to clump and form clots, a common cause of ischemic stroke. (Platelets are tiny cell-like particles in blood that help it clot in response to damaged blood vessels.) AspirinSome Trade Names
ECOTRIN
ASPERGUM
, one of the most effective antiplatelet drugs, is usually prescribed. One adult's tablet or 1 children's tablet (which is about one fourth the dose of an adult aspirinSome Trade Names
ECOTRIN
ASPERGUM
) is taken each day. Either dose seems to prevent strokes about equally well. Taking a combination tablet that contains a low dose of aspirinSome Trade Names
ECOTRIN
ASPERGUM
and dipyridamoleSome Trade Names
PERSANTINE
(an antiplatelet drug) is slightly more effective than taking aspirinSome Trade Names
ECOTRIN
ASPERGUM
alone. ClopidogrelSome Trade Names
PLAVIX
, another antiplatelet drug, is also slightly more effective than aspirinSome Trade Names
ECOTRIN
ASPERGUM
alone. It may be given to people who cannot tolerate aspirinSome Trade Names
ECOTRIN
ASPERGUM
. Some people are allergic to antiplatelet drugs or similar drugs and cannot take them. Also, people who have gastrointestinal bleeding should not take antiplatelet drugs.
If an ischemic stroke or a transient ischemic attack is due to blood clots originating in the heart, warfarinSome Trade Names
COUMADIN
, an anticoagulant, may be given to inhibit blood clotting. Because taking warfarinSome Trade Names
COUMADIN
and an antiplatelet drug or taking aspirinSome Trade Names
ECOTRIN
ASPERGUM
plus clopidogrelSome Trade Names
PLAVIX
greatly increases the risk of bleeding, these drugs are rarely used together for stroke prevention.
Treatment:
Anyone with symptoms of a stroke should seek medical attention immediately.
Doctors check the person's vital functions, such as heart rate, breathing, temperature, and blood pressure, to make sure they are adequate. If they are not, measures to correct them are taken immediately. For example, if people are in a coma or unresponsive (as may result from brain herniation), mechanical ventilation (with a breathing tube inserted through the mouth or nose) may be needed to help them breathe. If symptoms suggest that pressure within the skull is high, drugs may be given to reduce swelling in the brain, and a monitor may be put in the brain to periodically measure the pressure.
Other treatments used during the first hours depend on the type of stroke. These treatments include drugs (such as antiplatelet drugs, anticoagulants, drugs to break up clots, and drugs to control high blood pressure) and surgery to remove blood that has accumulated.
I hope it works!!! :-) |
