Re: migraine/TIA/basal ganglion hemorrhage/leg pain

Posted By kd on April 30, 1999 at 09:40:03
Hi.  Thanks for this opportunity.  As you can see, I have a couple of different questions.
1.  I have a hx of classical migraine.  I also have a left common cartoid that
     is completely occluded after carotid endarterectomy/carotid-aortic graft.  Dopplars show that the right common, external, and internal carotids are becoming occluded to the extent that surgery was being considered.  I was sent to a neurologist after some apparent TIAs.  The neurologist said that the results of the dopplar were most likely highly inflated due to the occlusion of the left common; that the right side formed a collateral to the left side and the pressure of the blood was changed by the constriction on the left side, creating a greater pressure on the right and changed dopplar scores.  I know from MRA that the right side flow is most responsible for flow in the left side Circle of Willis but there is nothing showing a connection between carotids peripherally.  The L external does feed the internal from a collateral but ...
? Does the neurologist's conclusion make sense?
2.  She also said that I am at very low risk of TIA/Stroke and should not consider my "episodes" as TIA but as migraine variant.  The problem I have with this is that when I have a migraine (I've had them for 40 yrs.) and when I have an "episode" they are very different.  They are different in the type and duration of visual aura.  If there is headache, they are different in type of headache.  If there is numbness, the duration is different.  On occasion, I will have a migraine that pretty much resolves when one of these other episodes hit.  However, I have always had a migraine before something else major hit - like appendicitis, ischemic colitis, a TIA just prior to the endartarectomy, etc.
? Can you have more than one type of migraine in at a time.
I have been dxd with TIA/RIND before but because there is nothing showing on the MRI, she says they were really  migraine variant.
? Do TIAs always show on MRIs?
I had a diamox spect test a couple of years back and it showed a fixed defecit in the watershed area and a mild transient problem that has since resolved.  These areas did not show on the MRIs.  I have residual problems from that but she says it is the result of the carotid occlusion and should not be considered TIA/stroke.  (I have doubts about this, too, because of timing factors.)
3. Do MRIs and MRAs always pick up the amount of plaque in the artery?
4. My father recently had what is diagnosed as a hemorrhagic basal ganglion stroke caused by high blood pressure.  He is 76.  He was released from the hospital before he was given instructions, etc. and the hospital has not forwarded his reports to the PCP.  His speech and writing skills were affected, as well as walking (for a brief time).  He is being told no driving, working in the yard, or in the garden (He's a "farmer" and also likes to work in their woods.)  Is there anything you can tell me about this?  They say his BP has to come down (approx. 140s-150s/90s to peaks at 101) before he is able to do anything but the inactivity is driving him "crazy".
5. Last one: Can Mitral Valve Prolapse and/or high systolic blood pressure cause plaque formation in other parts of the body ?  Is it possible that the peripheral vascular disease that I have is coming from those issues?
Thanks so much,
I've been waiting for months to ask and the questions started piling up.

[CCF Neuro[P] MD RPS]

Posted By CCF Neuro[P] MD, RPS on May 01, 1999 at 14:59:19
Dear KD;
Sorry to hear about all your problems.  To answer your first question, the flows in your right carotid should not be that elevated, although a mild-to-modest elevation may be possible.  The left side of your brain should be getting collateral flow from both your right carotid and vertebral arteries.  If your flows are really elevated, then I would want to know why, and this should be investigated by your stroke doctor.  To answer the second question, I would need to know what was the etiology of why you had your left endocarotidectomy?  It would be very unusual for a person to have two types of migraines.  TIAs would not show up on an MRI however, I would push for a MRI with diffusion when you have your next TIA.  If this is a real stroke then a change would be seen on MRI with diffusion where it might be missed on a regular MRI.  By definition, a TIA or RIND should not leave any focal deficit, therefore if you have a deficit then by definition, you have had a stroke.  The third question, no MRI will not pick up plaque.  Two tests, one would be a MRA but the gold standard would be an arterogram.  These would show changes in blood flow and hence either narrowing or plaque formation.  A doppler of the carotid would also show plaque or narrowing in the extracranial vessels.  I would agree with the doctors concerning your father.  HTN is the cause of his stroke and unless this is corrected, the next one will come.  No, plaque is not caused by mitral valve prolapse or high systolic BP.  However, these might make the situation worse.
I hope I answered some of your questions.
Sincerely,
CCF Neuro[P] MD










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Re: migraine/TIA/basal ganglion hemorrhage/leg pain CCF Neuro[P] MD, RPS 5/02/1999
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