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Are Loss Of Balance And Speech Articulation Symptoms Of A Stroke?

Posted on Thu, 8 Jun 2017

Question: Hi, my sister is going through something crazy right now. It happened a week or two ago. And it happened again yesterday. Her gait became as if she was trying to steady herself on a ship. Her speech is slurred. The first time, her depth perception was off. She has had MRI's and CT Scans, and bloodwork to test everything. She is an epileptic, so the first thing they though of at the ER was either a stroke or a seizure. The doctors have ruled out all of that. They don't know what is causing it. She will see her neurologist today, but I wanted to see what you guys think. You did so well with the last medical problem I had. Thank you for your time.
Now she has severe jerking going on. What on earth is happening?

Answered by Dr. Olsi Taka (1 hour later)

Brief Answer:
Imaging of neck vessels is needed (Angio MRI)

Detailed Answer:
I read your question carefully and I unerstand your concern.

If I understand you correctly the symptoms have regressed spontaneously, they were transitory.
The main concern with such symptoms is a stroke in the posterior part of the brain which is resposible for balance and articulation of speech. Fortunately the MRI was normal, meaning that no permanent damage was installed.
However that doesn't exclude the possibility of a TIA (transient ischemic attack), meaning a transitory lack of blood flow which may cause symptoms temporarily and leave no lasting damage on simple CT and MRI.
Now even if she has improved again a TIA, a repeat one in particular, requires attention as it may herald a future stroke. Such a repeated event may indicate narrowing of the neck vessels which causes reduced blood supply. It is important that she undergoes imaging not only of the brain but also of the vessels which supply blood to the brain in order to determine whether there is such narrowing and if yes its nature (atherosclerotic plaque, dissection are the most common cause), tests like Angio MRI (not sure what type of CT and MRI she had at ER, if only the brain or also Angio of the neck vessels). If such abnormalities are found will need treatment with blood thinners.
If blood vessels result normal then a heart evaluation is also necessary as heart issues such as arrhythmia may also create clots going to the brain.

I remain at your disposal for other questions.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Olsi Taka (43 minutes later)

THANK YOU SO MUCH. I WILL TELL YOUR RECOMMENDATIONS TO MY SISTER. SHE'S OVER 700 MILES AWAY, SO THERE'S NOT MUCH I CAN DO BUT SEND INFO TO HER. THANK YOU AGAIN. XXXXXXX

Answered by Dr. Olsi Taka (16 minutes later)

Brief Answer:
Read below

Detailed Answer:
Thank you for your kind words. By the way the addition about the jerking has come while I was writing my answer, so I am reading it only now.
While it doesn't change the opinion regarding balance and speech issue which as I said indicate more a blood supply issue, it does suggest a seizure being at play so an EEG should be done as well.

Let me know if I can further assist you

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Olsi Taka (4 hours later)

My sister's neurologist has admitted her to the hospital. She believes it has something to do with her medicines, but wants to do some more bloodwork and an EEG and other tests. Thank you again.

Answered by Dr. Olsi Taka (4 minutes later)

Brief Answer:
Should be for the best.

Detailed Answer:
I see, thanks for the update. Can't make any comment since we don't know her medication, but it's a good thing she's being admitted so she will be throroughly evaluated. I hope things work out for the best.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar