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Neurology (Expert Forum)
Neurologist and PCP disagree on stroke dx
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Neurologist and PCP disagree on stroke dx
by dixiedreams, Jun 08, 2005 12:00AM
I had what my PCP considers a stroke. I awoke about 5 wks ago with marked degenerative changes in my speech as well as some cognitive dysfunction. No damage to arms, legs, facial muscles, etc. Stupidly, I did not see the doctor until Friday. I'd had a TIA 2 years earlier and thought that maybe this would pass too. My blood pressure,intermittently high for about 10 years, was pretty high. His dx was stroke and he immediately sent me to the ER for an outpatient CT which showed a lacunar infarct. He also started me on ALTACE in addition to the TOPROL XL I take for PSVT. Recommended speech therapy, brain MRI, and a consult with a neuro. Also started PLAVIX. Radiologist read the MRI as suspicious with possible areas of encephalomalacia and recommended MRI with contrast and other tests to confirm or rule out any problems. Started speech therapy, began making progress. Finally got in to see neuro who saw me for about 5 minutes, said I was fine, and referred me to a psychiatrist. Speech therapist and PCP maintain that I did have a stroke. I have no idea what to believe. Should I get a second neuro opinion? Should I believe that my symptoms, which are still present after 5 wks, are in my head, that my therapist and PCP are idiots, and that I'm a nut case? Do I need the ALTACE and the PLAVIX? My instincts say if I did not have a stroke, then I probably do not. My speech therapist contends that there is no way I'd know all the "tricks" to fake if I was just a nut job and that I present pretty classically. I do not know what to think or what step to take next. Thanks for helping.
Doctor's Answer
by CCF-Neuro-M.D.-PW, Jun 09, 2005 12:00AM
Stroke can affect any area of the brain, so does not necesarily have to affect arm and leg function, and small strokes (like lacunes from hypertension) can affect just speech alone causing dysarthria.
An MRI can usually identify the stroke especially if a diffusion weighted image was done (I do not know if you had one), this can differeniate an old stroke/encephalomalacia from a new one. Encephalomalacia on a scan is more suggestive of an older stroke of at least several months old, and small strokes can occur without you knowing it. So I cannot tell for sure if the MRI showed a new stroke. Your symptoms are new though so this is more suggestive of a new stroke. Your cerebral and neck blood vessels should be evaluated also for any narrowings
It is extremely important to control your blood pressure whether you have had a stroke or not. With this event and your previous TIA and your stroke risk factors (cholesterol should be checked also) you probably should be on at least an aspirin. Aspirin and plavix are equivalent essentially, it just plavix is more expensive. A few trials showed plavix is slightly better, but aspirin is still the 1st line of treatment/prevention. Of course also avoiding tobacoo, excessive alcohol, and a regaulr diet and exercise os also extremely important
A second opinion can be obtained from the Cleveland Clinic Cerebrovascular Center if you so wish.
Good luck
An MRI can usually identify the stroke especially if a diffusion weighted image was done (I do not know if you had one), this can differeniate an old stroke/encephalomalacia from a new one. Encephalomalacia on a scan is more suggestive of an older stroke of at least several months old, and small strokes can occur without you knowing it. So I cannot tell for sure if the MRI showed a new stroke. Your symptoms are new though so this is more suggestive of a new stroke. Your cerebral and neck blood vessels should be evaluated also for any narrowings
It is extremely important to control your blood pressure whether you have had a stroke or not. With this event and your previous TIA and your stroke risk factors (cholesterol should be checked also) you probably should be on at least an aspirin. Aspirin and plavix are equivalent essentially, it just plavix is more expensive. A few trials showed plavix is slightly better, but aspirin is still the 1st line of treatment/prevention. Of course also avoiding tobacoo, excessive alcohol, and a regaulr diet and exercise os also extremely important
A second opinion can be obtained from the Cleveland Clinic Cerebrovascular Center if you so wish.
Good luck
