TIA or something else?

[cabkrun]

I am a 42 year old female in good physical condition.  I am a runner and cyclist.  About 3 months ago I had a "neurological episode" in which I was standing in our kitchen and felt a very quick, sharp pain in the left side of my chest, light headedness and then for a few seconds lost complete control of left limbs.  I ended up having to fall into a wall.  This lasted less than one minute, I recovered, told the hubby, and proceeded to lie down for a bit.  
An MRI was ordered by my GP, and results showed a subtle ischemic lesion.  However, a visit to a neurologist later left that questionable, as he wasn't convinced he saw the lesion.  He ordered a Transcranial Doppler study which indicated I had high grade right-to-left atrial septum shunting during both normal respiration and strain.  Because of the high grade shunt, he feels either a PFO or ASD contributed to my TIA.  The reason I am writing is because I wonder if I even had a TIA.  
I know it wasn't a seizure, because it presented completely different, yet the duration of the hard core symptoms were so short.  Has anyone on this board been diagnosed with having a TIA with such a short duration of the symptoms?  I have been experiencing a lot of light-headed feelings (at one point my vision became blurred), along with frequent runs of PVC's and left sided chest pressure for about a year now.  I have always been told such symptoms are benign.  Before I have a lot more cardiac testing (Besides the "bubble test" I had an echo that showed mild mitral and aortic regurgitation) and have whatever heart hole I might have closed, it would be nice to know whether I truly had a TIA or it was some other weird thing.  
I am not sure if anyone I've seen knows for sure.
Sorry for the long post, and if it's inappropriate in this forum.  I just don't want to have any unnecessary surgery for the wrong diagnosis.

[cabkrun]

Sorry, spell check made the H into and l  ..

[cabkrun]

Joel, just to clarify, because this event had such a rapid onset, and the possible lesion on the MRI, we ruled out migraine with aura.  It was a matter of a second when it came on... I was standing, next thing my left limbs were gone.  Felt as tho my brain shut off.
Thank you for your comments.

[cabkrun]

Hi Abhijeet,
yes we are pretty certain it was a TIA.  I have never had headaches, and definitely not migraine.  Because it essentially felt like my brain shut off, and I lost control of left sided limbs, we will say it was a TIA.  I do not know if speech was involved, because I didn't attempt to talk when it was happening.  
Right now I am working with a couple of cardiologists and trying to decide on my options for closure.  I really do not feel comfortable with the device closures.  I don't feel they have enough history, clinical trials, etc.  Open heart doesn't sound fun either, but I would prefer to do it as a 40 year old, than as a 65 year old having someone go back in and retrieving that device that has started to corrode or something else.  A foreign object in my heart sounds unappealing to me.  
The high grade right to left shunt is also something to be careful of.  We cannot tell from the TEE whether I have an ASA or not, as the study was not very thorough.
Thank you so much for your post.  I appreciate your thoughts and input.
Joel, thank you for your comments as well.  We have essentially ruled out any migraine cause.  :-)

[Abhijeet Deshmukh, MD]

Hello.

That episode does look like a TIA. It was a definite neurological deficit, short lasting (less than 24 hours) and improved rapidly.

TIAs can be so subtle that people often miss them. Your heart condition is playing a role in the TIA. Hope you get it taken care of. You could discuss the options of treatment for the high grade shunt.

Regards

[JoeH]

google Migraine aura without headache.
Can be seconds to hours.
YES, you COULD have had a tia, often no lesion is there, but the aura is more common.

[cabkrun]

Hi Dave,
Sorry to hear of your problems.  I also continue to have lightheaded feelings, lots of palps (PVC's) etc.  I am glad you are having the TEE, but would they also be willing to do a bubble test first?  It's far less expensive, and very accurate.  A TEE would be needed if you decide on closure.  
It has absolutely been concluded that I had a TIA.  They symptoms from a TIA can be a few seconds in duration.  Did you ever get an MRI done?  If the episode is brief, a TIA will often not show on an MRI, so it might be a waste.  GOOD LUCK.  Let me know how things go for you.

[Davo595]

I just found this forum and posted a similar post to yours...  I am 44 and in excellent health.  About 6 weeks ago I had the left side of my body go numb for a few minutes and then I was fine.  I am a business owner and was going through a very stressful day.I went to the ER and was diagnosed with a TIA.  Here I am 6 weeks later with daily lightheaded feelings and some slight tingling on my left side.  A neurologist and a cardiologist said TIA's have no lingering effects.  I beg to differ...
I am having a MRI next week and a TEE (sophisticated Echo) also.

David