Having Consistent Seizure Or A Form Of Stroke. Normal With Aging? Treatment?
The flow voids of the skull base are unremarkable. The visualized paranasal sinuses, mastoid air cells and orbits are normal. The skull base and calvarium are intact. IMPRESSION: 1. No acute intracranial pathology.
2. A few scatted white matter lesions in both parietal lobes most consistent with chronic small vessel ischemic disease. Vasculitis and demyelinating disease could have a similar appearance, and these are clinical possibilities.
My family told me that the day before I slept most of the day and seemed normal.
Since going to the ER, I have been able to recall some of my memory which required a lot of focus and tired me. I am also having trouble focusing and following and do not feel that my cognitive abilities are normal. And I am more tired than normal I have also experienced additional memory loss since the initial incident.
About 2 months ago, I experienced severe headaches that would last for days and had a swollen lymph gland behind my left hear. So went to the doctor ordered CT with no issues.
Before ordering the EEG, the neurologist made reference to a potential seizure and that the EEG would help with providing additional data for diagnosis. MY QUESTION: FROM THE DATA THAT I PROVIDED ABOVE, IS IT CONSISTENT WITH A SEIZURE OR A FORM OF STROKE OR IS THIS JUST NORMAL AGING. WHAT SHOULD I EXPECT NEXT IN MY JOURNEY OF GETTING A DIAGNOSIS AND WHAT ARE TYPICAL TREATMENTS?
Thank you for posting your query. I appreciate the detailed description provided by you, as it helps a lot.
I agree with your neurologist that the two possibilities in your case include minor brain stroke or a seizure. I would consider stroke as the first possibility. The kind of stroke thst would lead to memory loss as in your case would be transient global amnesia (TGA), a form of transient ischemic attack (TIA), also called as minor brain stroke.
The MRI brain shows features of ischemia (lack of blood flow to brain).
Further investigations would include finding out the risk factors for stroke such as high BP, high sugar, cholesterol or homocysteine. Carotid doppler and echocardiogram are also advisable.
Medications would include aspirin and statins. Anti seizure medications may be given empirically for some time.
I hope it helps. Please get back if you have any more queries.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad
Thank you for your assistance.
TGA (transient global ischemia) refers to a type of brain stroke (lack of blood flow to the brain) where the predominant symptom is memory impairment, and the person recovers within or after a few hours to a few days.
I am sure you would completely recover, as there are no acute infarcts on the MRI, suggesting that there is no permanent tissue damage in brain.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Sorry to bug you more.
When can I expect to feel normal again with respect to memory and energy?
Why is the EEG needed?
Also, I attached the results of my blood work. Do you see any red flags for risk factors? (e.g., high sugar, cholesterol or homocysteine).
Thank you!!
You would feel better with respect to memory and energy in a week or two.
EEG may help in diagnosing a seizure disorder.
I do not see any attachment here. May be you can upload them again.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
I greatly appreciate your assistance. You have helped me significantly to better understand. I am looking forward to identifying my risk factors so I can avoid this situation in the future.
Thank you again!!
CBC WITH DIFFERENTIAL RESULTS
Component Results
Component Your Value Standard Range Units
WBC 5.9 4.8 - 10.8 10^3/uL
RBC 4.46 4.10 - 5.30 10^6/uL
Hemoglobin 13.1 12.0 - 16.0 gm/dl
Hematocrit 39.5 37.0 - 47.0 %
MCV 88.6 81.0 - 99.0 fl
MCH 29.4 28.0 - 32.0 pg
MCHC 33.2 32.0 - 36.0 g/dL
Platelets 269 150 - 350 10^3/uL
MPV 11.2 7.4 - 10.4
Neutrophils Relative 58.0 50 - 70 %
Lymphocytes Relative 31.5 20 - 40 %
Monocytes Relative 9.4 2 - 11 %
Eosinophils Relative 0.5 1 - 3 %
Basophils Relative 0.3 0 - 1 %
Immature Granulocytes Percent 0.3 0 - 0.4 %
Neutrophils Absolute 3.4 1.8 - 7.7 10^3/uL
Lymphocytes Absolute 1.9 1.0 - 4.8 10^3/uL
Monocytes Absolute 0.6 0.1 - 1.4 10^3/uL
Eosinophils Absolute 0.03 0.0 - 0.3 10^3/uL
Basophils Absolute 0.02 0 - 0.2 10^3/uL
Immature Granulocytes Absolute 0.02 0 - 0.03 10^3/uL
RDW 15.5 <16.5
r BASIC METABOLIC
BASIC METABOLIC
Component Results
Component Your Value Standard Range Units
BUN 17 5 - 25 mg/dl
Sodium 140 135 - 146 mmols/L
Potassium, Bld 4.7 3.2 - 5.0 mmols/L
Chloride 104 95 - 112 mmols/L
CO2 34 18 - 32 mmols/l
Glucose, Bld 98 70 - 115 mg/dl
Creatinine 0.7 0.5 - 1.5 mg/dl
Calcium 9.6 8.1 - 10.2 mg/dl
Anion Gap 3.00 5 - 20
Glom Filt Rate, Est > 60 >60
GFR MDRD Af Amer > 60 >60
They are all normal here. Among the risk factors for stroke, I found only blood sugar values here, which are normal.
So, if you have lipid profile (cholesterol) and homocysteine values, please send them too. If they have not been done, please get them done.
Dr Sudhir Kumar MD DM (Neurology)