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Is Temporary Lack Of Motor Control In Right Arm A Concern?
Question: White male, 68 yrs. old, history of quadruple by-pass about 6 years ago. Currently experiencing temporary lack of motor control in his right arm, i.e. he wanted it to go right, but it went left. That happened last night and he says "he's better," but today is unusually tired. Any cause of alarm?
Brief Answer:
He should be evaluated for possibility of stroke as soon as possible.
Detailed Answer:
I read your question carefully and I understand your concern.
The fact that he has had a by-pass in the past means that he is a person who is at risk for vascular issues. The same way his heart vessels (I suppose you mean coronary by-pass) were occluded, it is possible for vessels supplying other parts of the body, the brain included, to be involved. So he is a person at high risk for stroke.
For that reason reading at that description there is a cause for alarm as what you describe could be a manifestation of stroke, lack of blood flow to a certain area of the brain due to an occluded vessel. It could be an area which controls movement or coordination for his right limbs. Stroke is a medical emergency. So I believe he should be checked right away, in the ER, in order for a neurological exam to confirm whether there is indeed a lack of strength or coordination of the limbs, or other neurological signs and if this suspicion is confirmed have other imaging tests and start treatment.
I remain at your disposal for further questions.
He should be evaluated for possibility of stroke as soon as possible.
Detailed Answer:
I read your question carefully and I understand your concern.
The fact that he has had a by-pass in the past means that he is a person who is at risk for vascular issues. The same way his heart vessels (I suppose you mean coronary by-pass) were occluded, it is possible for vessels supplying other parts of the body, the brain included, to be involved. So he is a person at high risk for stroke.
For that reason reading at that description there is a cause for alarm as what you describe could be a manifestation of stroke, lack of blood flow to a certain area of the brain due to an occluded vessel. It could be an area which controls movement or coordination for his right limbs. Stroke is a medical emergency. So I believe he should be checked right away, in the ER, in order for a neurological exam to confirm whether there is indeed a lack of strength or coordination of the limbs, or other neurological signs and if this suspicion is confirmed have other imaging tests and start treatment.
I remain at your disposal for further questions.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for the above. Based on your response, I got him to go to the ER and yes, he had, had a stroke in a blood vessel in the back, left side of his head. I guess it was a TIA. He was hospitalized until today. I brought him home around 2:30 p.m. EDT. It is now 5:15 EDT. He has slept since we got home. Before we left the hospital, he had plans to run errands and go to his office. Now, he's down and out. My question: is this normal to be so tired and sleep so long?
Thank you.
Thank you.
Brief Answer:
Read below.
Detailed Answer:
Hello again!
If the tests showed a lesion in a blood vessel territory then it is a proper stroke not a TIA (transient ischemic attack) where as the name suggests symptoms regress in less than a hour and there are no lesions on imaging. Now to judge on what symptoms he should have and what is normal is a little difficult without having any knowledge on the exact area involved, without the hospital reports. However since he was discharged so quickly I would assume it was a small stroke, not involving areas dealing with conscience.
Generally speaking I would say that it may be normal after a stressing experience such as this to sleep for some hours (from what I understand it's 2 hours 45 min when you wrote the query). Only if you see that he is not arousable, it is not possible to wake him up, then it is a cause to worry about the possibility of a stroke recurrence.
Let me know if I can further assist you.
Read below.
Detailed Answer:
Hello again!
If the tests showed a lesion in a blood vessel territory then it is a proper stroke not a TIA (transient ischemic attack) where as the name suggests symptoms regress in less than a hour and there are no lesions on imaging. Now to judge on what symptoms he should have and what is normal is a little difficult without having any knowledge on the exact area involved, without the hospital reports. However since he was discharged so quickly I would assume it was a small stroke, not involving areas dealing with conscience.
Generally speaking I would say that it may be normal after a stressing experience such as this to sleep for some hours (from what I understand it's 2 hours 45 min when you wrote the query). Only if you see that he is not arousable, it is not possible to wake him up, then it is a cause to worry about the possibility of a stroke recurrence.
Let me know if I can further assist you.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you. I'm honestly not sure exactly what it was. They said it was a mini-stroke and I took that to be a TIA. That and the fact that as Saturday wore on, he became increasingly better! But there have been no residuals other than his words start to slur just a little as he tires. They said that was normal. He is up and about now, and took a shower. I'm watching him closely and definitely, if he was unarousable, I'd call 911. I am not letting him drive tonight. Not sure when I'll let him do that, though the hospital put no restrictions on him. I'm not convinced the hospital was all that great. They had a disconnect as to whether or not he should be given his blood pressure pills that he takes 2x a day! As of Sun. night, they hadn't given him any. He hadn't had any since Sat. a.m. His pressure was rising. So I brought him the meds from home and he took them. All they were giving him was an aspirin, so I figure there wouldn't be any contraindications if he were to take his normal pill regimen. We didn't tell them. Today, they were pleasantly surprised to see his BP had decreased! I just say this because I'm not sure I got the proper/enough info. I'll just keep an eye on him. Thanks for your quick response!
Brief Answer:
Read below.
Detailed Answer:
It is good to know he's up now. I would not let him drive for a few weeks. There is no precise time when to start driving because stroke can manifest in so many ways, so the ability to drive depends on what deficits it has left behind, on his actual condition, if he has trouble with balance and coordination, or visual field restriction then naturally he can't drive.
Regarding the blood pressure issue, while high blood pressure is a risk factor for stroke and should be treated in the long term, in the first few days it is often preferred to leave it a little higher than normal, generally systolic pressure up to 185 mmHg is not aggressively lowered in the first day, it is preferred to be lowered gently by about 10% a day. That is because that raised blood pressure is a reflective defense response of the body trying to reperfuse with blood that area. So while I do not know the exact values that might have been the reason he wasn't given any pills for blood pressure initially.
As for Aspirin, that and a statin are the main preventive treatment for stroke, unless there is found some heart source for the stroke such as arrhythmia. But in order to judge for that as I said it is necessary to know what tests he's had.
I hope to have been of help.
Read below.
Detailed Answer:
It is good to know he's up now. I would not let him drive for a few weeks. There is no precise time when to start driving because stroke can manifest in so many ways, so the ability to drive depends on what deficits it has left behind, on his actual condition, if he has trouble with balance and coordination, or visual field restriction then naturally he can't drive.
Regarding the blood pressure issue, while high blood pressure is a risk factor for stroke and should be treated in the long term, in the first few days it is often preferred to leave it a little higher than normal, generally systolic pressure up to 185 mmHg is not aggressively lowered in the first day, it is preferred to be lowered gently by about 10% a day. That is because that raised blood pressure is a reflective defense response of the body trying to reperfuse with blood that area. So while I do not know the exact values that might have been the reason he wasn't given any pills for blood pressure initially.
As for Aspirin, that and a statin are the main preventive treatment for stroke, unless there is found some heart source for the stroke such as arrhythmia. But in order to judge for that as I said it is necessary to know what tests he's had.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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