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Difference Of Opinion Aboute Stroke/TIA
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Difference Of Opinion Aboute Stroke/TIA

There is a difference of opinion between my Primary Care Physician and a Neurologist as to wether I've had a stroke/TIA.
I believe this difference is due to my symptoms being strongly suggestive of a stroke, while all the tests I have taken find no evidence of stroke or TIA.
I'd like your advice please.

I am a 54 year old male. I have good blood pressure, am not diabetic nor a smoker. I've had the following tests:
Closed MRI/MRA with and without contrast
MRA
Echocardiogram
Stress Test
C-Reactive Protein Test

All results came back normal. My PCP believes that proves nothing.  The symptoms still suggest stroke, and otherwise healthy people die every day from stroke or heart attack.
Short of finding an innocent explanation for the symptoms, he has me extremely worried that a disaster is in my near future.

I can't detail all my symptoms here and I fear that the "Reader's Digest" version will only reinforce the idea of a stroke, bute here they are:

1) A sudden severe attack of motion sickness which abated somewhat overnight but was steady for 10 days and lingered for several weeks more.
2) A week after the attack, I had facial symptoms involving much of the left side including a slight numbness in the cheek.  Numb feeling turned to irritation/tightnesss/flushing within a few hours. Over several weeks, areas of the face would seem clear, but other areas would become invloved, then the previously clear areas would have symptoms again.
3) I have noticed some stuffiness in the left ear. At one point, the tragus became extremely tender to the touch.
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None of you symptoms seem particularly convincing for a stroke.

The chance of a future stroke increased with the presence of stroke risk factors, these include high blood pressure, diabetes, high cholesterol, smoking, and evidence of atherosclerosis in the brain, neck or heart blood vessels. You seem to have none of these (make sure that all the intracranial and neck blood vessels were evaluated in the MRI sufficiently)
therefore your risk of a future stroke is low pending you maintain your healthy lifestyle.

Some strokes do not appear on MRI if they are brief or if the blood vessels which is compromised is opened very quickly ie within a few minutes. These kinds of stroke smay produce symptoms which last for several minutes, rarely beyond one hour - this does not sould like your case.

If your symptoms have persistes as long as your are due to a stroke they should show up on a good MRI scan. Sometimes decreased flow in the blood vessels without a stroke can still produce symptoms - this can be evaluated with ultrasound of the neck and intracranial arteries, or a brain SPECT scan looking at adequacy of brain blood flow. Rarely a slight tear in an artery can produce transient stroke like symptoms undetected by MRI - a cerebral arteriogram can pick this up. Again, these rare causes of MRI negative stroke do not fit our story.

There may be a more local problem as you rsymptoms seem to localize to the left ear/inner ear area which includes the facial nerve, inner ear balance/dizzy system - this line of investigationmay be more revealing. A seconds opinion from another neurologist if you are still uncertainmay not be a bad idea.
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