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TIA - A-typical Migraine?
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TIA - A-typical Migraine?

About a month ago, my husband starting having TIA's. In three weeks time, he had 7 of them. 3 of them happened in a short period of time and lasted approx. 8 hours total. The rest didn't last anymore than maybe an hour each. After 4 emergency rooms, 3 hospital admissions, numerous CT scans, MRI and MRA's, blood work, etc., they determined that what ever the problem was, was not neurological so they branded it an "A-typical migraine". They prescribed Calan 180 mg and sent him home. So far, 16 days later, no attacks. However, he still has numbness in his right hand and arm if he over-exerts himself. I know you probably want more information, however I am very frustrated. It seems as though they wanted it labled because they couldn't find anything else and just dumped it in that catagory. Does this sound right? He has hypertension and is on meds for it, but these TIA's are very scary for all involved. Thanks very much in advance for your help.

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Avatar_n_tn
The term TIAs means essentially strokes, so should be used with care.
An episode that lasts several hours in duration more likely than not will show up on MRI (especially the diffusion image). Migraine is a diagnosis of exclusion in this setting (a focal neurological deficit) - but if MRI and MRA are negative it becomes much more likely.

'Atypical' migraine is a misnomer, as this type of migraine is typical for the more correct term, complicated migraine, or complex migraine. It is a real entity, and Calan or other calcium channel blockers are the treatment of choice. The neurological deficit can last from hours to days. Triptan (like Imitrex) are relatively contraindicated - the cause is thought to due to spasm of the cerebral arteries - hence no permament strokes show up on the MRI. It runs in some families, and in these cases is due to a genetic mutation of calcium channels. The diagnosis is a clinical one, and treatment is usually effective.

Numbness in the hand or arm with exertion can be related to a narrowing in the artery to the arm (the subclavian artery) so this should be checked out. This may be missed even on MR imaging of the neck vessels if this area is not covered.
8 Comments
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Avatar_f_tn
I started having tingling & numbness that was sporadic in the extremities 2 weeks after having my daughter in 2002. I had her vaginal w/ an epidural. I had many tests, & my doctors could never figure out why I had these symptoms. The neurological problems seem to have subsided w/ time, but about a month ago, I developed a strange headache that comes and goes. It began in the left front lobe of my brain. I have a cavernous and venous angioma in the deep left front lobe, which I have been aware of for a while now. The headache is one sided in the left front part of my head, near my forehead. It is a pulsating pain. It is sporadic, and can lasts a few minutes, or hours. I don`t always have nausea or light sensitivity like most migraine sufferers, but I have experienced those symptoms at times. I seen my neurologist about this recently, and he said what I was describing was a migraine, and that he didn`t think my angiomas (abnormal cluster of blood vessels that is congenital) was related to the headaches. He gave me some samples of Immitrex, and sent me on my way. I tried the Immitrex when I get the headaches, but it doesn`t seem to help. I`m just wondering though... are these probably migraines, or angioma related? Or something else? I had a recent MRI that was normal, except for the angiomas, which are considered incidental findings.... Any comments are appreciated.
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Avatar_n_tn
I should add that he has had no headaches associated with this.
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Avatar_n_tn
HI TRACY WHEN YOUR HUSBAND HAS HIS ATTACKS CAN HE TALK AND MOVE?DOES HIS VISION GO TO A RED OR GREY COLOR?HOW LONG DO THEY LAST?A TIA ATTACK IS A MINI STROKE.THEY CAN DAMAGE MANY AREAS OF THE BRAIN.TIA ATTACKS USUALLY JUST A FEW MINUTES.THEY DO NOT LAST HOURS.YOU SAID YOUR HUSBAND HAS HYPERTENSION,BUT IS BEING TREATED FOR IT,HAS YOUR HUSBAND EVER HAD HIS HEART CHECKED?SOME TIMES IF THE HEART IS NOT PUMPING ENOUGH BLOOD TO CERTAIN AREAS OF THE BODY,YOU WILL GET NUMBNESS IN THOSE EXTREMITIES.TALK WITH HIS DOCTOR ABOUT ANY CHANCE OF THIS SINCE HE DOES HAVE HYPERTENSION.TAKE CARE OF HIM AND YOUR SELF.TNT406
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Avatar_n_tn
Last week I experienced what a neurologist first called a TIA. I looked up the symptoms and everything fit; the quick onset of numb right arm, vertigo, speech garbled and my right arm would 'float up' without my intension. This all lasted a couple minutes and I was back to normal. My MRI and MRA were normal. I will be having a TEE next week. My neurologist now believes there is a possibility that it was a migrane (migraine). She said this because since the left arm went numb,showing problem with the right side of my brain, my speech should not have been affected, due to language being in left side of brain.
  I have never had a migrane (migraine) in my life (37 yrs) and neither has anyone in my family, including grandparents. I also didn't have a headache at all with this episode. I fear that if there is no proof to back a TIA I will be diagnosed with 'migraine sufferer' and will just be left to "wait and see when the next one hits". Any thoughts? Thanks
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Avatar_n_tn
I am eighteen years old.  A couple months ago I went on a two day hiking trip with a freind.  On the second day I was exhausted and had to lay down. Once I laid down, my left thigh went come plently numb.  After a little while I got enough energy back for us to gt home, however my left thigh was still completely numb.  After we got home, I started going numb from head to toe, so I was rushed to the emergency room.  They did catscans and mri's but said nothing was wrong with me and sent me home.  By this time I had regained all feeling except for in my left leg.  Over the next few weeks I went to aboiut four doctors trying to find an answer for this strange occurence.  The only suggestion anyone could give me was an a-typical migraine.  However, I wasn't told what the typical symptons of this is, or if there is any treatment, or if I can expect another attack.  Any advice?  Oh yeah, and my left thigh is still completely numb.
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Avatar_n_tn
i have also been diagnosed with having tia s ,they want to scan my neck as they think maybe the problem lies there .

in 1999 aged 29 i woke up one morning and my speach slurred and i couldnt focus on anything ,they performed an mri and found a clot in my cerrebelum.for weeks before this happened i suffered with dizziness,pains in my neck and the back of my head .they said it was stress. i was discharged from hospital after 3 days with just instructions to take 75mg of asprin to disperse the clot and prevent further more.

last week i had another attack and this time my lip was left droopy fro 3 days ,my asprin was upped to 300mg a day and i am now waiting to go for a scan.

it always starts with neck pain for a few days then the pains start in my left arm and i get pains only in the back of my neck for a few week then it happens another tia ,no one listened to me last time when i said i was getting neck pains .


ellilou



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Avatar_n_tn
I have become quite an expert at deciphering confusing medical diagnoses'. Unfortunately, my neuro. history perplexes almost every Neurologist who sees me. As far as worrying about the symptoms described being a TIA, since that hasn't shown up on any imaging; I would be looking elsewhere for an explanation of the problem. I have complex migraines that have left ONE SIDE of my body paralysed for several hours, many times. Just like with a major stroke, my face sags, my eyelid is most of the way closed and unable to be opened completely. The oddity is that the Complex Migraines, even though much more annoying and scary than the regular migraines, they don't have as much pain and sometimes there is no pain with them, just a weakened state, numbness or both, usually on the right side of my body. I started getting migraines approx. 8 yrs. ago while pregnant w/ my 1st child. Although, I am unsure that is why, because during the pregnancy I was bitten by a rabid dog, which lead to a series of excruciatingly painful Rabies vaccinations. I was also outside barefoot in a puddle of H2O. The tree next to me was struck by lightening. The roots lead all of the way over to my foot and I suffered the shock of a lifetime. All three of these things could have predisposed me to migraines. However, 3 yrs. later, I found myself diagnosed with a tumor in the Pineal region (center) of my brain. They also found another tiny tumor in the right side (where the majority of my migraines happen) The tiny tumor didn't reappear on consecutive MRI's.

I had brain surgery. They removed my occipital bone, split the hemispheres of my brain and removed a small cyst and tumor with glial tissue growth. It was benign, but I was informed that if it had more time to develop, it may have taken root and become some type of Glioma (a malignant tumor). After this, I developed an abscess and was called a Hypochondriac for about the next 5 mos. by the majority of Dr.'s who saw me. They told me that: if there was an abscess, I would be bed-ridden. I don't think they liked my style of self-diagnosis. Anyhow, long story short: I DID have an abscess. It took them 6 months to find it. It was MRSA and Pseudomonus. I had the abscess debrided. Then it came back much larger and added the complication of Meningitis. When they re-opened my head again for the 3rd time, they also found an Osteomyelitis of the occipital bone. They said I would unlikely ever be rid of this infection 100% permanently.

I did not sue, even though I went through all of my records and found that the MRSA was there immediately after the first surgery and NOBODY did anything about it, other than tell me that I was a Hypochondriac. Three months later, I had my 4th surgery. I had a Methylmethacrylate Cranioplasty, which basically left it impossible to reach any future problems in those areas of my brain. Since then, I have been given the medical run around many times. One time they (my PCP) thought I had meningitis or a return of the MRSA. The hospital kept me for 9 days and released me saying nothing was wrong. When I read my medical records, I noticed that I had Meningial irritation and enhancement on my MRI and a Lumbar Puncture that came back with a scant growth of MRSA with an identical susceptibility report to the prior growth. My PCP told me that I had bacterial meningitis, especially since I was placed on a 6 month antibiotic protocol, even though they said they found nothing wrong.

Throughout the years, I've had many episodes that seem to be seizures, but they haven't ruled them out from complex migraines either. I recently (over the last 6 mos.) started having fevers and other symptoms that are similar to when I had the abscess. About 5 mos. ago, I had an infection in my shoulder with NO entry point that they speculated may have traveled from my brain. At that time, I had a negative MRI of my brain, but there was a very tiny lesion in an area on my cerebellum near the old abscess site. Then in October, I went to the ER and they did an MRI of my brain. It showed a 7 mm lesion, where there was nothing 4 months before. It was in the right insular cortex. I believe the area corresponds with the second small tumor 5 years before that disappeared, but they said that if they didn't see it all of that time, it must have been under 1 mm. They also said that if it was a tumor and it grew that quickly from less than 1mm to 7mm in 4 mos. time, it may be a sign of malignancy. However, they cannot rule out infection.

Then, I believe they realized that they re-opened my statute of limitations (if this was an infection) and they said there wasn't anything wrong with me and sent me home. I went to the hospital where my Neurosurgeon worked out of and the MRI they did there also showed a brand new fluid collection on my cerebellum. It did not enhance. This was the same finding as before when I had the original abscess. All bloodwork and LP's came back negative back then and now they were similar, but there were a few findings in my bloodwork that correlate with another infection. However, they (once again) insinuated that I am a hypochondriac (although all of their attempts to prove this by psychiatric evaluations failed and the Psychiatrists agreed with my side). Then my Neurosurgeon who promised to follow me for the rest of my life, due to the serious complications that could come about at any time, DECLINED to take my case and suggested I seek a second opinion. He knows full well that he is one of very few people qualified to take my case and I could die without his help. Yet he would not see me, likely because the hospital which I could have had a 7 figure law suit against has recently had a merger with the institution he works for. So, I have become a dollar sign and not a person, despite the fact the I am not vindictive and did not sue in the past. Now, I must start from scratch at the Mayo Clinic which admits this is a very complicated and possibly a very serious case.

I am very disappointed with Barrow Neurological Institute and Dr. Porter for turning their backs on me in a time of need. I have two young children who need me and I am not very capable anymore as my problems are progressing. I am in constant pain and am very limited by allergies, on which medications I can take. Despite everything, I love life, I love my family, I am not depressed and I want to live and get back to life ASAP. I live in AZ (Phx area)and if anybody knows a REALLY good Neurologist or Neurosurgeon without a God complex, I would love to hear from you.
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A related discussion, complex migraine was started.
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