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Neurology (Expert Forum)
Stroke - diagnosis and questions
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Stroke - diagnosis and questions
by jkrishna, Oct 24, 2006 12:00AM
BACKGROUND: On 9/17, my father felt a numbness on the right side of his body - mouth felt a "pull" & he had difficulty signing. He had an aspirin & went to a doc who said it was TIA. But the symptoms did not disappear in 24hrs.It is now a month since; he is fine but still has a little difficulty signing. He met a neurosurgeon the next day who asked him to undergo tests. Here are some results:
ECG: "aortic valve sclerotic"
HOMOCYSTEINE: 65 (recommended <13)
CT SCAN: "Focal low attenuation in the left thalamus".
MRI: My father felt a pain in his neck when he was strapped;also claustrophobic, so did not take an MRI.
DOPPLER TEST: nothing unusual
LIFESTYLE :
No smoking/drinking, vegetarian. Age, 58. Has had high blood pressure for 20yrs, controlled by medicaiton. Diet quite balanced. Smoked for 5-6 yrs; stopped about 30 yrs back. Works in a desk job, not much exercise. Drinks 5-8 small cups of coffee. He had a similar numbness about 10yrs back, but tests revealed nothing. Family-mother had a stroke at age 70.
Doctor's diagnosis:
Acc to the neuro-surgeon, the high homocysteine caused a minor stroke. He has prescribed vitamin b, folic acid and plagril (pill with aspirin) for life.
My questions:
*Is the diagnonsis conclusive enough?
*Is high homocysteine a cause/symptom/fall out of a stroke?
*What is the risk of recurrence, given he's now on aspirin for life?
*He often has ulcers in his mouth;is it ok for him to be on aspirin?
*He now walks 30 min and has cut coffee.Is this enough?
*Any other tests he shd undergo?
*Is it ok to start driving?
Appreciate your advise!!
ECG: "aortic valve sclerotic"
HOMOCYSTEINE: 65 (recommended <13)
CT SCAN: "Focal low attenuation in the left thalamus".
MRI: My father felt a pain in his neck when he was strapped;also claustrophobic, so did not take an MRI.
DOPPLER TEST: nothing unusual
LIFESTYLE :
No smoking/drinking, vegetarian. Age, 58. Has had high blood pressure for 20yrs, controlled by medicaiton. Diet quite balanced. Smoked for 5-6 yrs; stopped about 30 yrs back. Works in a desk job, not much exercise. Drinks 5-8 small cups of coffee. He had a similar numbness about 10yrs back, but tests revealed nothing. Family-mother had a stroke at age 70.
Doctor's diagnosis:
Acc to the neuro-surgeon, the high homocysteine caused a minor stroke. He has prescribed vitamin b, folic acid and plagril (pill with aspirin) for life.
My questions:
*Is the diagnonsis conclusive enough?
*Is high homocysteine a cause/symptom/fall out of a stroke?
*What is the risk of recurrence, given he's now on aspirin for life?
*He often has ulcers in his mouth;is it ok for him to be on aspirin?
*He now walks 30 min and has cut coffee.Is this enough?
*Any other tests he shd undergo?
*Is it ok to start driving?
Appreciate your advise!!
Doctor's Answer
by CCF-Neuro-M.D.-SH, Nov 06, 2006 12:00AM
First of all, keep in mind that I am unable to diagnose you because I am unable to examine you, this forum is for educational purposes.
I agree that from the story you provided it sounds like your father had a small stroke in a deep area of the brain that damaged some of the 'wires' that control the right side of the body. The stroke was almost certainly due to his hypertension. Hypertension is the leading cause of stroke, and causes narrowing of small ateries that feed the deep structures in the brain (such as thalamus, internal capsule, basal ganglia, etc.) a process called lipohylanosis (even with medicine). High homocysteine is thought to contribute to the risk of vascular disease, but the exact contribution is less clear. I agree with starting the B vitamins and the aspirin. However, I would suggest some more tests. First, you need to have an idea about the health of your cerebral vessels. This can be obtained by MRA (magnetic resonance angiography), CTA (Computed tomography angiography) or by carotid duplex and transcranial ultrasounds. If there is a stenosis, then the risk of recurrent stroke will be higher. Second I would recommend a echocardiogram of your heart, to assess your ejection fraction, the health of your valves (it sound like there may be a problem from your post), and to evaluate for a PFO (small hole in the middle of the heart). I would also suggest that you wear a heart monitor (HOLTER) for at least 48 hours to make sure your heart is not beating funny (atrial fibrilation), because this can lead to strokes and requires a different medication (coumadin). You should also have your cholesterol checked and take a statin if needed. Ulcers in the mouth are not a problem with aspirin. Aspirin is only a problem if you ave ulcers in your stomach or GI track. Driving is very often possible after a small stroke, but I would suggest that you see an occupational therapist that specializes in driving assessment to make sure everything is safe. I would focus on finishing your workup with the tests I described, diet and exercise, address your cholesterol as needed, take daily aspirin and control your blood pressure as well as possible.
I hope this has been helpful.
I agree that from the story you provided it sounds like your father had a small stroke in a deep area of the brain that damaged some of the 'wires' that control the right side of the body. The stroke was almost certainly due to his hypertension. Hypertension is the leading cause of stroke, and causes narrowing of small ateries that feed the deep structures in the brain (such as thalamus, internal capsule, basal ganglia, etc.) a process called lipohylanosis (even with medicine). High homocysteine is thought to contribute to the risk of vascular disease, but the exact contribution is less clear. I agree with starting the B vitamins and the aspirin. However, I would suggest some more tests. First, you need to have an idea about the health of your cerebral vessels. This can be obtained by MRA (magnetic resonance angiography), CTA (Computed tomography angiography) or by carotid duplex and transcranial ultrasounds. If there is a stenosis, then the risk of recurrent stroke will be higher. Second I would recommend a echocardiogram of your heart, to assess your ejection fraction, the health of your valves (it sound like there may be a problem from your post), and to evaluate for a PFO (small hole in the middle of the heart). I would also suggest that you wear a heart monitor (HOLTER) for at least 48 hours to make sure your heart is not beating funny (atrial fibrilation), because this can lead to strokes and requires a different medication (coumadin). You should also have your cholesterol checked and take a statin if needed. Ulcers in the mouth are not a problem with aspirin. Aspirin is only a problem if you ave ulcers in your stomach or GI track. Driving is very often possible after a small stroke, but I would suggest that you see an occupational therapist that specializes in driving assessment to make sure everything is safe. I would focus on finishing your workup with the tests I described, diet and exercise, address your cholesterol as needed, take daily aspirin and control your blood pressure as well as possible.
I hope this has been helpful.
