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Transient Ischemic Attack
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Transient Ischemic Attack

My 55 year old wife has just returned home from a stay in the hospital with suspected TIA.  She had the full battery of tests, such as MRI, doppler on the carotid arteries, echocadiagram and CT scan.  None of these tests showed anything unusual.  One year ago she had a "cardiac event" which showed dialated cardiomyopathy with an EF of 25-30%.  After meds to bring her blood pressure under control and regular exercise her EF had risen to about 60%.  She seemed to be doing just fine.  Last week she complained about numbness "not quite right feeling" in her right arm.  It abated and then returned later in the week, along with numbness in her leg and face all on the right side.  After about three hours, she called her doctor and was told to go to the ER.  Although the initial blood work-up was negative it was decided to admit her based on her past history.  In any event, after the five day hospital stay and the tests showing no conclusive evidence, it was diagnosed as a "very small thalamic reversible ischemic deficit which has cleared" by the consulting neurologist. She was placed on Aggrenox, a blood thinner and removed from Prempro. She is now home and the symptoms have largely gone away. I guess the theory is that somehow part of her brain was compromised but although we have been married some 28 years, I cannot determine any difference in her behavior or ability to do her daily activities. She has been asked to cut back on her exercise beginning next week.  
My question is this.  Even though the tests showed nothing to substantiate this diagnosis, is it possible there could be other disease processes that would mimic the symptoms of a TIA? Any other thoughts or suggestions would be greatly appreciated.
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Dear Richard:

I am sorry to hear about what your wife has been going through.  The good thing is that all of her tests have been normal, but the question is whether all the tests have been done.  When they echo'd the heart, did they conclusively conclude that the myopathy has resolved, no vegetations on any of the valves, and holter monitored the heart to make sure there wasn't an arrhythmia that might come and go.  Did they do a complete lipid profile (fasting), homocysteine work-up, and maybe a Leden Factor test?  What was her blood pressure in the hospital, before the event and after release from the hospital.  I ask these things because the etiology of the two events would be useful to know.  One would want to prevent a major stroke and to do so, the etiology of the event needs to be treated.  What did the MRI with diffuse sequence show?  To have symptoms that last for hours is really a small stroke and likely would be shown by the latter neuroimaging.  

You mentioned that symptoms have largely gone away, does this mean that there is some symptoms still present?  There are only several things that are abrupt and then resolve and also have a neurological focus.  These would be stroke, seizures, tics, and migraine headaches.  Without knowing more about the symptoms she had during the event, I can't tell you much.  I would seek a second opinion from a stroke doctor concerning the etiology of her events.  Two events so close together has an etiology and your wife needs to alter whatever the etiology seems to be.

I hope that you find out what the etiology of her events might be.

Sincerely,

CCF Neuro MD
2 Comments
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Avatar_n_tn
One other additional fact.  The numbness in her right leg has actually be reported earler over several weeks and it may have only been coincidental that it recurred at the time of the other symptoms. I'm wondering about possible disk problems.
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