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Forum Name: Neurology Topics

Question: Transient Ischemic Attack diagnosis


 catlover1 - Sun Jan 04, 2009 9:12 pm

Back in March, 2008 I was diagnosed as having a TIA after a sudden loss of feeling in my right arm and right side of my face. I had a complete battery of tests including MRI and MRA of brain and circle of willis (I am having another brain MRI tomorrow to see if there is any change since March), ultrasound of carotids and heart, MRI of spine, complete blood work and everything checked out normal (only anomalies were %50 block in right external carotid and small hole in heart). Since then I am now on my third round of symptoms (have gone months feeling OK only to have symptoms return) including tingling on the left side of my face, weakness in my right arm and weakness in the back of my neck which usually is accompanied by nausea. I am getting frustrated with my Dr because evreything always comes out normal, yet i feel terrible most of the time and I think he is running out of tests to do. I am 43, never smoked, no drugs, light drinker. BP is normal 117/78 average , cholesterol was 235 back in march but I have brought it down under 190 now. I am slightly overwieght at 183. I am on Plavix and Ramapril. My entire life I have been blessed with good health until now. If anyone has any other ideas of what I should do next, i would appreciate it. Thanks.
 John Kenyon, CNA - Mon Feb 16, 2009 1:40 am

User avatar Hello --

I think I may have spotted, in your post, the underlying cause of the problem. You say that in the course of all the workups following the initial TIA that "...only anomalies were %50 block in right external carotid and a small hole in the heart." It is this latter I suspect may be the cause or at least the culprit. You see, usually when there is found "a small hole in the heart" it is a patent foramen ovale (PFO), a small hole in the wall separating the upper chambers of the heart. It is something that exists in utero and serves a purpose during that period of development, but usually closes before full development.

PFO is associated with stroke or TIA in about 40% of people who are known to have it. The reason is not clearly understood, but it is a fact, and repair of the hole, a simple insertion, by catheter, of an "umbrella" type closure, is usually an in-and-out affair.

I would strongly suggest you discuss this with your doctors, and, if necessary, seek a second opinion form a cardiologist or different neurologist. With this problem generally everything else will show up normal on tests, and correction of the PFO often puts an end to the neurological issues, at least to the extent that irreversible damage hasn't been done.

I hope this is helpful to you. Good luck with this and please follow up with us as needed.

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