Have I had a TIA?

[CrBu]

I am a 24 year old male, no previous medical problems.
Recently i experienced a blinding sensationation in my right eye and then couldn't see anything horizontally down in my right eye(only had half vision in that eye), I felt very strange and my right arm felt disconnected (hard to decribe I could move it but not with much co-ordination). I then spoke to someone but found my words were muddled and basically nonsense (I couldn't even think of what I wanted to say). After a few minutes these symptoms stopped but I then got a very bad headache. The headache seems to come and go but nowhere near as bad as the night it happened. This happened about two weeks ago, I keep experiencing things but i'm not sure if i'm imagining them, for example - it feels like my hand is shaking but when I look I'm sure its not and today it suddenly felt very cold, generally my right arm (and leg but not as much) feel strange. I have seen my doctor and have been referred to a nurologist, but no one will even tell me what they think it might be. There are other sypmtoms but i'm not sure how relavent they all are, like I am getting very confused with simple things - which tooth brush is mine etc.
I am a train driver and it happened at work three weeks ago, luckily I wasn't driving at the time but I have been taken off driving indefinatly. I'm struggling to find information on anything it could be that means I will still be able to drive.   Does this sound like a TIA?

[theflyjd]

Let me start by telling you that your concerns are valid. I have had 4 strokes. 2 of those 4 strokes were considered TIAs at first but were later recatagorized as strokes. My first stroke surprised me. I didn't know that I had a stroke. I had a blinding headache and then my right ear started ringing. Thinking I had an ear infection, I went to an ear doctor who put me on antibiotics. After a couple of weeks with no change in the level of headache and ringing (Tinnitis) I had an MRI that showed evidence of a severe stroke. I had the very same symptoms as you; right side numbness, vision changes, weakness and confusion. I'm sorry you live in the UK where treatment might be a little more difficult to receive but I would reccommend you see a Neurologist as soon as you can. My delay in seeing one cost me hearing in my right ear and, perhaps, left my pain incurable. You are young so if treated soon the chances of a full recovery are good so see a Neurologist soon! Good luck.

[catherineandre]

When you go to your Dr office? neurologist again take a member of your family with you because he is less inclined to treat you like a 'numpty' if there is someone in the room with you.
Write down all your questions on a peice of paper?
TAKE CONTROL OF YOUR HEALTH CARE WITHOUT GETTING ANGRY. BUT GET THE RESULTS THAT YOU WANT - INFORMATION.
You never know you may have had to be warfarin or heparin and it is all being missed because of the slow health system!

[catherineandre]

Do you thing I have had a right or left vertebral artery dissection?
Did you do a CT and MRI of my neck?
Are there any lesion or which matter seen on my scan?
If I have had a TIA what do you think is origins are from?
If this is a migraine do I have white lesions or matter on my brain?
Do you think I have a anurism?
Is there any thrombi lesions on my brain?
Do I have damage to my brain stem, pons or cerebrum?

[catherineandre]

I understand your frustration but here is what you should do.
Write a typed letter to your GP and neurologist's office requesting an URGENT copy of your medical records. Do not state in the letter why you need the letter, only say you need them urgently. It is the British system and it will be slow. State in the letter that you authorize the release of your medical records to yourself. State your name and date of birth as a heading underlined after Dear Sir/Madam. Addres the letter to Medical Records and NOT your DR.

Give them a couple of days to received the letter then called them and ask them if they received it. Get the number by calling thehosiptal and asking for the medical records office.

Being sure that they have received it. Tell them on the phone that you need them urgently for your new DR that you may be getting. Only tell them this if they ask why you want them. You never know you may have to get a new Dr or a second opinion. After you have the medical records you need to get a copy of your CT scan and MRI/MRA. Did you have a MRA? It is more conclusive but you have to use a dye called Gadolinium to get good pictures.

You need to work the system. Chivey them along. I just got copies of all my records but it took a month. I plan to see a new Dr when I am well enough to leave the house. I am due to get a second opinion soon.

[CrBu]

After days and days of more stress and waiting I have found out very little. I saw my neurologist today and after waiting 2 hours in the waiting room he greeted me with "what are you doing here then". He knew nothing of my CT scan and seemed uninterested. I was then told to wait so they could go and get the radiologist report, after which I was told the scan hadn't been looked at yet. They then asked me to wait and they would write the report while I waited. After another 45 minutes I was told it was unlikely it would be finished today and they would ring me with the results on wednesday. My neuros last words to me were "I don't expect it to show anything so I wouldn't worry". I'm at the point of anger with my situation as the neuro seems to be treating me as a hypercondriact, at what point does anyone seem to care??? He has almost convinced me i'm just imagining everything, but then I remember how this all started and know I didn't imagine that. Why is my neuro acting like this - I'm sure if CT scan comes back showing nothing then he's going to say there's nothing wrong with me (which would be nice if it were true). He doesn't seem to want to find out what happened or what is wrong, he just wants to tell me what isn't wrong.
Advice please, what should I do?

[catherineandre]

You can get you medical notes by requesting them and signing a release. It is my experience that some medical staff ie  DR and nurses will not be frank with you and tell you exactly what is wrong. You should sign a release of your file to yourself so that you can read for yourself the diagnosis and not be dependent on someone 'softing it up'.
The fear your have is normal. I had trouble sleeping for 3 weeks because you are terrified that you are going to have another stroke. It is a naturalr eaction. You need to rest though so your brain will heal. You also need to drink good volumes of water (2 litres) eat a high protein diet and fruits and vegetables. Stay away from large volumes of sugars. Take some small walks.
LOOK AFTER YOURSELF FOR HEALING AND KEEP YOURSELF CALM.

[CrBu]

I completly understand what you are saying, but -

I sit at home all day by myself worring about everything, restless, confused and as the day goes on I feel worse and worse. When I went into work I seemed to relax and feel a bit better, also if something was to happen again being at home by myself is not ideal.
The doctors have yet to tell me if i did have a stroke maybe when someone finally tells me I did then I might not worry so much as to what it might be and be able to just sit down and relax. I know this sounds stupid and I'm angry at myself for not being able to just sit and relax. Ironically before this happened I would look forward to days off work and spend most of my time watching movies/TV, but now no matter how tired I get i'm always restless and worried and just can't sit still.

Does anyone else know of someone or maybe themselves that after a possible TIA has difficulty with objects and colours? For example If I look at a blue t-shirt I recognise the colour but I have to stare at it and then say the colour and even then I'm not sure I got it right. I started noticing this after each day being confused as to which tooth brush is mine, sitting by the computer now I know which is which, but and I've tried this - if I were to go and get mine now I take about 5 - 10 secs staring at them to decide and have got it wrong once or twice.

Surely these symptoms aren't from a migraine??? If so I think I'm going nuts. How do I describe this type of thing to neurologist when I see him on monday.
I tried to tell him before but he just gave me a wierd look so I stopped and said I was probably just imagining it.

[catherineandre]

I had a stoke 6 weeks ago. I am of work. You should be of work. You should not be working. You need to rest so your brain will heal. What are you thinking?
YOU need quietness and need to keep yourself calm.
Your need to be careful or you could have another stroke.

[CrBu]

Something that has worried me that I just noticed is that I think I have very poor peripheral vision in my right eye. I have been finding it hard to focus on things as if I have to look at them through my left eye, difficult when talking to someone to look them in the eyes, but I didn't think much of it. Now I realise that I am trying to look in the centre of my vision which because of this peripheral vision loss has moved left of normal.

Neurologist did a peripferal vision test (counting finger on edge of vision) and i'm sure I failed it, I even told him I was just best guessing with my right eye compared with my left eye where I could clearly distinguish how many.

I guess I should just wait to see neurologist but I am so often told by family not to worry and even docs tell me it's probably nothing to worry about that I am desperatly trying to get answers - as no one around me seems to be taking me seriously or the other extreme when I tell my wife or mum things like this they can get very upset.

Do peripheral vision problems indicate anything?

Many thanks in advance for any replies.

[caregiver222]

In the United States we have "stroke specialty Centers". These hospitals specialize in diagnosing potential stroke complications. The value is that you have a concentration of physicians and established protocols. They are pretty good. There are no realrules, but sudden onset of symptoms suggest a clot. Gradual onset suggest a bleed. Take special care if you find yourself sensitive to sunlight. That's pretty definitive for a bleed. The primary cause of bleeds in someone your age is simple vitamin K deficiency. A tremendous amount of damage coming from a very simple problem. And they don't screen for this. Write down every thing you eat in the same diary you keep for your symptoms. I'd be very interested in what the scan results are. It is difficult, if not impossible to deal with most health care systems. On the one hand you need to be agressive, but on the other, you don't want the doctors to get mad at you. They should have been a bit more agressive in interpreting the scan. That is because there is a window of opportunity in treating these kinds of problems. If youcometo the UnitedStates and want a scan that night the magic words are "loss of consciousness". "I blacked out". That gives you an immediate admission and usually an MRI scan. In public hospitals such as those where I used to work we never asked for insurance coverage information. The privates and so-called "voluntaries" do. In the United States, if they don't want to treat you because you have nocoverage request treatment under the "Hill-Burton" Act. The hospitals don't tell people about this act because they can only bill a smallpercentage of patients under this system and they try to restrict that number to those who REALLY can't pay. Hill-Burton requires any United States hospital recieving federal funding to treat a certain number ofpatients without regard for insurance coverage.

[caregiver222]

I think your physician seems to be taking you a bit more seriously. As you have probably guessed I am a train buff. My rail experience is minimal, dating back four decades when I had the privilige of breaking my back hand bombing a pretty little 2-8-0 I had worked on with a rail museum to restore. And I subscribe to "Trains",  and read upon all the rail technical publications. One of the big problems in hospitals in the United States is that they get a lot of"pseudo-patients" with vague complaints, such as "headache". There is a tremendous amount of hypochondria going around. I think initially you were not given the attention I would have provided. We have a system called triage, and oftimes these patients get shifted to the side. I guess it's the same the world wide. I want you to get a little permanently bound book and keep track of your symptoms and your blood pressures and pulse. And symptoms. What were you doing when the symptom came on, the duration of the symptom, the intensity, and the exact location. Walk the cat back and think about if you had any similar episodes anytime in your life.  It is unusual for the bloodpressure numbers to change as they did in your case, but not impossible. Some of the good electronic cuffs are quite good. In the United States a few so-called "diagnostic centers" have sprung up. These pride themselves in not being connnected with a hospital nor in providing treatment. Just tests and a diagnosis. I'm a little out-of-date in  recommending one. There are a variety of different scans and scan options. I think you have handled yourself responsibly. I bounced your symptoms around with a few friends and we couldn't come up with a direction. The scan may or may not show something. There are other kinds of scans and the electroencephalogram. Medicine changes from year to year and currently they have the "decison tree" system is in vogue. It's a tree with a series of "if-then" options and arrows. These trees don't always take the place of a good hunch. The thing is that physicians have a "monologue" that insulates themselves from the reality of life and death. The only people who care about you are your family. To the world you are a number. I am agravated at your physician for not ordering special tests quickly, but these days everything is constrained by protocol, unless your name is George Soros. There is a possibility that you suffered what is sometimes called a "petitmal" siezure, which come in various shapes and sizes. Anyone can get one of these and they often involve a loss of a sense of time for several seconds or minutes. You can get one from exposure to flickering light or watching television. Helicopter pilots get them from watching the sun flicker through the blades sometimes. A loss of attentiveness. Migraines are difficult to diagnose and there are many opinions. Many people suffer ocasional migraines throughout their lives and live productive otherwise healthy existences. Try to request a full copy of your medical records and tests. Often, some hospitals  will only provide these to another physician. In the future, if you get a scan, ask the technician whether or not all the information is saved. Taking large numbers of images uses up electronic storage space. Some machine have a cartridge that keeps this data, and they overwrite the information. Ask the technician if you purchased such a cartridge and provided it to him, could the entire record of the scan be transferred for you to keep. Technology changes rapidly and the memory cartridges used a few years ago are unreadable today on any machine, but it's something to ask about.Keep track of the names of all physicians and health care professionals you see and visit. It's easy to forget who you saw and what they told you. I would bring a digitized recorder to the physician briefing sessions and keep it in my pocket. The magazine "Scientific American" has some excellent issues on the functioning of the brain and this month they have a special issue that you would find of interest. I would not worry about driving a private vehicle, but if you start to have symptoms,pullover to the road. If you are susceptible to "petit mal" siezures, they generally provide warning.

[CrBu]

Caregiver222 - No problem about previous posts, seemed a bit harsh when I first read them but following posts more than make up. My company (First Capital Connect previously Thameslink) has an agreement with union that any driver who is deemed medically unfit to drive anymore will get 80% drivers pay doing any other job within the company. I assume this would be to stop people hiding potencially dangerous medical problems.


Had CT scan yesterday, but got to wait until monday (2nd April) to see neuro with results. I don't know if this means anything but i've had strange head aches since this first happened (they seem to come and go and start off as a warm feeling), when I had the CT scan it gave me a very bad head ache in the same place, and later my wife told me my right eye was slightly higher and pointing to the right (this happened a few weeks back too).

I went in to work today, luckily I get on well with my manager, he has arranged some work for me (at my request). It's something I think they just made up - I have to go in friday at 1800 and wait for all the evening arrivals to come in and count how many go through a wash road before being stabled in the sidings. Not very exciting but it'll give me a chance to go in, see people and take my mind off things.  

After I got home I started to slur words again and my lip and cheek started feeling strange and being a bit droopy. Again not sure if I'm imagining it.

Also my friend lent me a blood pressure monitor and last night I woke up feeling very strange (almost as if I should be running - hard to explain) but I took my BP and it was 168 over 135 (I'm assuming this was a mistake) but as the BP unit squeezed my wrist I suddenly felt a lot better and when I checked it again strait after this it came up as 112 over 60. Surely the smaller number being as high as 135 has to be a mistake???

Anyway I always look forward to any and all replies, any advice or ideas etc. very welcome

[CrBu]

Just so no one worries or tells me I shouldn't - when I go into work the company was given strict orders by the work doctor that I can only do office type work and cannot be left alone - also I'm under no obligation to stay for any amount of time or any number of days

I want to go in as I think worrying at home has been making me feel worse .  

[caregiver222]

Asan asside, there is an old saw about someone approaching a physician to talk about"a friend of his who has thisproblem..." I believe you have established yourself as a UK driver, however,if I were an engineer working on an American Railroad seeking a solution or advice I might pose as a UK "driver" and state "I am nolonger driving"topreclude any further investigation as to my situation. To cover that eventuality I attempted to convey the seriousness of the situation with which it is viewed by the DOT.I said to myself: "This guy might be working as an engineer now in the U.S. regardless of what he said."  When lives are at stake, one sometimes has to take the chance of being offensive to save them. But I didn't mean to take your problem lightly.

[caregiver222]

There are several sides to every story.  I believe (and still do) that you require much better medical care that you have been getting and my point was to utilize a megaton bomb to push you in that direction.  Medicine is an art and not a science, and sometimes things can't be explained. Sometimes it is not possible to get provide a diagnosis. American physicians use the Merck manual as a standard of treatment, the PDR (physicians desk reference) as a drug handbook, and follow very established protocols for dealing with potential "strokes". American hospitals use the term "rule out".Thus, they will writeon your chart "rule out myocardial infaract". If you ever watch the television series "House" you can see how difficult it is to diagnosis many cases. As in that television series, the best result takesplace when there is input from a number of physicians. American teaching hospitals use this procedure.As we both know, rules and regulations are one thing and feeding your family is another. The ends are at times mutually exclusive. Concealing one's medical history ispossible and happens all too often in the transportation industry. Sometimes (in my opinion) tough love is requiredto get someone to appreciate their situation, especially when the lives of others are at stake. Something is cauysing your problems and that something should be identified. The terms "stroke" and "TIA" aren't very helpful. Such terms are defined by the Stedman's medical dictionary, which is helpful to purchase or research yourself on-line.  I want you to make a pain-in-the-neck of yourself to your health care provider until you are absolutely satisfied you know what has gone wrong with you. There are many potential etiologies, some with grim outlooks, and some that will resolve themselves with time. Sometimes interactions between medicationsor medications and alcohol or exposure to such things as the PCB's used in the transformers of some commuter rail equipment could cause such symptoms. You need tests, and you need them as soon as possible. In American hospitals, the word is STAT.  You should realize I certainly did not want to make fun ofyou. Good luck.

[Ronrey]

First of all, let me tell you how sorry I am that you are experienceing such horrible medical conditions.  Even though I don't know "caregiver22", please let me also apologize for the attack that he/she launched against you in response to your origianl posting.  Obviously, "caregiver" did not notice that you said you were at work when the symptoms first happened AND that you were now not driving.  Not all Americans are that rude, short-sighted and self-absorbed.

As for your condition, I have no medical expertise, but I would say there are definite neurological issues that need to be addressed.  Please continue to seek help (second, third and fourth opinions if necessary) even if the UK DOES have horrible healthcare.

I will pray for your full and speedy recovery.

[CrBu]

     My wife is American so she's forever telling me how crummy Health care is here (england) and I cannot argue.
     It almost seems as if the docs treat it as a possible migraine untill proved otherwise, surely if there is a possibility of a stroke they should treat it as one untill proved otherwise not the other way around. As I've read a TIA could progress to a Stroke I might not be able to tell them I told you so.
     Saw my works doc last friday (23rd March), same as neuro reflex tests and the phrase "I'm sure it's nothing to worry about" but no answers. Although I was expecting more of a you'll never drive again attitude, but he seemed uninterested as if I was off work with a cold.  
     I've read other posts here and relate to some, but I can't seem to describe things well enough for docs or my wife to understand, like when talking to my wife this morning half way through a sentence I couldn't remember what I was meant to be talking about. Just dont feel myself, several times i've found myself just standing in a door way between rooms and am completly blank as to why i'm there or how long i've been there. Every so often my words are muddled or slurred but not enough for anyone to notice. I'm sick of being told it's nothing and I'm probably just imagining it and normally you probably wouldn't give things like that a second thought. I know I'm not right, but I can't explain it, and even when I think I have the Doc or whoever i'm talking to doesn't seem to care.

[CrBu]

Continued'

Just to add my works doc was very easy to talk to and was the first to explain all the tests he was doing and give me feed back (other docs just starred at me over their glasses and said "i'm sure its nothing to worry about"). He said my BP was 155 over 90 which apparently is slightly higher than he would have wanted, and wasn't happy I smoke about 20 cigarettes a day (more since all this worry started). Also he said he noticed that my right arm was weaker than my left, which I tried to explain has gotten better over the last few weeks and is no where near as bad as it was. But i'm right handed and a slight weakness in the arm that's normally stronger feels like a big difference to me but I couldn't seem to explain this to him.

p.s. Passenger crowding wouldn't be as much of an issue these days through london if we'd used the wider guage. Instead longer trains and platforms are the only answer. I was told recently about a railway somewhere in germany I think that uses a narrow gauge something like 2 and a half feet.

[CrBu]

Interesting posts some parts not as helpful as others, I drive 319 EMU passenger trains between Bedford, London and Brighton mainline railway(England), yes there is a dead man and a vigilance device goes off every minute of inactivity on controls which must be acknowledged within 7 secs. I have broken no laws, rules etc. I was working a Shed turn when it happened (working units between main staion and carridge sidings) I have been off work since pending Medical examination and results. I HAVE BEEN to emergency and I can confirm I do live in england and medical care is poor at best - I waited 2 hours to be seen and was told to go home and see my own doctor on monday as there was nothing they could do on the weekend, this was the main reason I was seeking more information.
I completly agree that if what happened to me 3 weeks ago is likely to happen again or has damaged part of my brain then I should not be allowed to drive, but I was seeking information on if it was likely to be a TIA or possibly something less serious.
I saw a neurologist yesterday who quickly came to a convienient conclusion that I had had a classical migraine, but to be safe sent me for a blood test, monday I will have the scan.
Tomorrow I am going to see my works doctor in London - Personally I beleive if migraines can cause effects almost identical to a stroke/TIA then they are just as bad and the doc will probably think so too.
WHAT CONDITION WOULD YOU PUT MONEY ON????

[caregiver222]

I have a lot of sympathy for you and am not your enemy. Please understand that. I suggest you come to the United States for an evaluation. You have recieved crummy care. There are a number of possibilities, from a tumor to an infection, to a clot, to a bleed, to debri momentarily blocking a blood vessel to a momentary spasm of blood vessels which impinged oxygen flow causing death of tissue. Take heart. Sometimes these events don't happen again. You need a sequence of imaging evaluations to compare and contrast changes that might take place between the day of the evaluation and three, six and twelve months in the future. I had a minor neurological problem, checked into an emergency room in the United States and had a complete MRI scan within 60 minutes. And a second one thirty days later.  This is the standard of care. I also believe you have taken your situation seriously and maturely and did not mean in any way to insult you. Something is going on inside your head, and the explanations you have recieved to date have been inadequate. Good luck.

[caregiver222]

By the way, the Boeing 747 was designed by British aircraft engineers, lured away by higher benefits by Boeing. My favorite British Railroader was Sir Alfred Kingdom Brunnel, whom devised a railway with a seven foot guage. Had his guage been adopted warfare would have turned out differently because the dimensions of modern armor is determined by the width of a railway carriage. The Germans in WWII had two types of tracks. Narrow ones to fit while the tanks were on rail flatcars, and aide road tracks when they came off them. You also need a good toxicology screen. There are substances that can cause symptoms of the kind you experienced.

[caregiver222]

You have symptoms of neurological damage, sometimes, but not always associated with brain tissue death secondary to oxygen deprivation. You should be evaluated at a stroke specialty center and not by a single "neurologist" who "will order tests". You would meet admission criterion for an evaluation if you say the magic words "I blacked out". Loss of consciousness is grounds for admittion. If you have not had an MRI you have had exceedingly poor medical evaluation. If there is no good medical facility in your town/city travel. You should have had an MRI within hours of you reporting the symptoms. Take heart in thre fact that the brain had great redundancy, but you need a diagnosis.

[caregiver222]

Now you don't say what you are driving, but the problems associated with your condition vary from a blackout to a loss of situational awareness. In a blackout, you have a dead man, unless you have it disconnected. But there was a head on in New Jersey (A cornfield meet) in 1996 due to a lack of situational awareness secondary to a diabetic engineer. Depending on what you are running that loss of situational awareness can end up with a runaway. There was that runaway on Sherman Hill on the old UP. Three SD-40-2's and 81 hoppers, lost his air, (you know how it on hills, release, running, lap and emergency)  inadequate retainers, failed dynamic braking, and everyone went to hell on a curve at 120 miles an hour. You know the nold song: "He whisered a prayer, as he pulled on the air, and he knew he had run his final race. " His last words to his wife was "till we meet at the Golden Gate good-bye." So get a good medical evaluation. You owe it to your passengers, the people al,ong the right of way, your wife, your mother and your kids.

[caregiver222]

Here's the bad news. You may be from the U.K. because in the United States we call em' hoggers. Or maybe a light rail line. If you are on a class one railroad you are in violation of 49CFR209.303 by continueing to work, rest assured there is prison time associated this with violating this rule. And the guy on death row whose medical care I have a tort action against the warden to get improved medical care tells me the food is really horrrible.  On a local level all you have to worry about is being charged with the "D" felony of reckless endangerment. So your career as a "train driver" is over for at least a year. Don't pass go. Don't collect two hundred dollars. The good news is, that although you have experienced a TIA, these events are often cauesed by dehydration and inactivity in normal people. What part of going to a hospital with a good stroke center isn't clear to you? The symptoms you have experienced endanger yourself and others. GO TO AN EMERGENCY ROOM.