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Question: I am having daily episodes on TIA like symptoms. I awoke the other day and could not talk for about 30 seconds. I had no control over my right arm like it fell asleep. Bot legs were numb and weak as was my arms. I had no balance. I had a severe headache in te back of my head in the neck area on the right side. Loud ringing in the ears and a feeling a disconnection. Almost as if I'd smokes marijuana. I had a momentary feeling of not knowing here I was. And of course, I was in a panic!!
These attacks happen almost every time I wake up. It doesn't matter if I sleep 3 hours or 20 minutes. I have COPD and have high co2 level. LIke 67-72. And sometimes 80's. I also have been realizing that I de-sat at night and have woken up with a pulse ox reading of 71 to the lower 80's. I have visual symptoms of a migraine aura and am very sensitive to light and sound. And I am in a constant brain fog and having balance problems.
I have had a workup that has included a brain MRI, Caroted scan, CT Scan, Spinal tap, Echocardiogram. All unremarkable except that one carotid scan showed 50 blaockage and the other scan was normal at another facility. So, there is a contradiction...
Was just discharged from XXXXXXX Clinic yesterday in this condition because they said insurance would no allow me to stay and find out what is wrong. They simply ruled out an acute stroke but refused to help me.... They want me to return as an outpatient which I can not do. I am in a wheelchair on oxygen, do not drive and live 2 hours away from them. I was sent there by ambulance from a local ER.
What are your thoughts? I need HELP! I am non-functional right now and scare I might be in danger. No one will help me. They keep saying everything is chronic and want me to wait & wait.........
These attacks happen almost every time I wake up. It doesn't matter if I sleep 3 hours or 20 minutes. I have COPD and have high co2 level. LIke 67-72. And sometimes 80's. I also have been realizing that I de-sat at night and have woken up with a pulse ox reading of 71 to the lower 80's. I have visual symptoms of a migraine aura and am very sensitive to light and sound. And I am in a constant brain fog and having balance problems.
I have had a workup that has included a brain MRI, Caroted scan, CT Scan, Spinal tap, Echocardiogram. All unremarkable except that one carotid scan showed 50 blaockage and the other scan was normal at another facility. So, there is a contradiction...
Was just discharged from XXXXXXX Clinic yesterday in this condition because they said insurance would no allow me to stay and find out what is wrong. They simply ruled out an acute stroke but refused to help me.... They want me to return as an outpatient which I can not do. I am in a wheelchair on oxygen, do not drive and live 2 hours away from them. I was sent there by ambulance from a local ER.
What are your thoughts? I need HELP! I am non-functional right now and scare I might be in danger. No one will help me. They keep saying everything is chronic and want me to wait & wait.........
Brief Answer:
Symptoms are suggestive of TIA.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted your symptoms and the investigations done so far.
I agree with you that these symptoms are suggestive of transient ischemic attacks (TIAs).
MRI may be normal in 50% of cases of TIAs.
You should be started on oral anticoagulants in view of atrial fibrillation. The best option today is dabigatran tablets, as there is no need to do regular blood tests to adjust the dose by PT/INR monitoring.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
Symptoms are suggestive of TIA.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted your symptoms and the investigations done so far.
I agree with you that these symptoms are suggestive of transient ischemic attacks (TIAs).
MRI may be normal in 50% of cases of TIAs.
You should be started on oral anticoagulants in view of atrial fibrillation. The best option today is dabigatran tablets, as there is no need to do regular blood tests to adjust the dose by PT/INR monitoring.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
are you sure they are not just migraines? Can you have a TIA several times a day?
Brief Answer:
More like TIAs.
Detailed Answer:
Thank you for getting back.
Thank you for getting back.
Yes, your symptoms are more like YIAs.
TIAs are more likely to occur several times a day, rather than migraines.
Also, migraine episodes by definition should last four hours or longer. On the other hand, episodes of TIAs can be very brief.
I hope it helps.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
More like TIAs.
Detailed Answer:
Thank you for getting back.
Thank you for getting back.
Yes, your symptoms are more like YIAs.
TIAs are more likely to occur several times a day, rather than migraines.
Also, migraine episodes by definition should last four hours or longer. On the other hand, episodes of TIAs can be very brief.
I hope it helps.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
But why would it happen every time I wake up from sleep? I am afraid to go to sleep. I am a fall rish and they have me om 325 of asprin once a day instead of coumadin. I have a very stiff neck, ringing ears and blocked sinuses. Also very bad dental issues w/ 5 broken teeth that may be infected. I also have a trache and breathing has been very bad lately and co2 levels have been very high. are you sure of TIA's? This is very scary. HOW do i know when these are an emergency? The local ER is treating me very badly because they think I am a faker. I have been there 12 times this month (May) and every time, they only do a CT scan to rule out a stroke and then send me home. They are making fun od me and being VERY nasty. I am afraid I will have a real stroke and they will overlook it. Te last time I was there. they put me in a room and ignored me for over an hour with no call light. I was not even on a monitor. I am very afraid..
Brief Answer:
I can understand your discomfort.
Detailed Answer:
Thank you for getting back with more information.
It is unfortunate that you have multiple medical problems and on top of that, you have symptoms of TIAs.
TIAs are more common in mornings especially early mornings. This observation may be due hemodynamic changes with blood pressure and heart rates in early mornings.
It is unfortunate that your doctors are not compassionate. I only hope that you get the desired/required attention for your neurological problem. Please see a neurologist and get MRI brain done.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
I can understand your discomfort.
Detailed Answer:
Thank you for getting back with more information.
It is unfortunate that you have multiple medical problems and on top of that, you have symptoms of TIAs.
TIAs are more common in mornings especially early mornings. This observation may be due hemodynamic changes with blood pressure and heart rates in early mornings.
It is unfortunate that your doctors are not compassionate. I only hope that you get the desired/required attention for your neurological problem. Please see a neurologist and get MRI brain done.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I had an MRI XXXXXXX done. It was normal. The image quality wasn't the best becuase I have dificulty breathing while laying flat and these is always some movement on the film. But I had TWO mri's that were normal. The doctors have refuse to do a CTA or MRA. I have had one carotis scan that was 5-% on the left side. It wa repeated at XXXXXXX Clinic and they said it was normal on both sides. My co2 was high and I did have a slight elevation of trponin T. All four sets were in the indeterminate range but CCF failed to do anything about it.
I meant carotid scan at 50% on one test on the left side and CCF said that was normal on their scan. So, we have a contradiction.......
I meant carotid scan at 50% on one test on the left side and CCF said that was normal on their scan. So, we have a contradiction.......
Brief Answer:
MR or CT angiogram should be done.
Detailed Answer:
I have noted your the test reports.
To resolve the contradiction/doubts in reports, an angiogram is necessary. This could be either MR or CT angiogram.
A correct diagnosis is important to determine the best medical treatment.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
MR or CT angiogram should be done.
Detailed Answer:
I have noted your the test reports.
To resolve the contradiction/doubts in reports, an angiogram is necessary. This could be either MR or CT angiogram.
A correct diagnosis is important to determine the best medical treatment.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Do you mean a CTA or CT Angiogram where they go in the groin and feed catheter up to carotids? I am scared to have the later done.... How accurate would the MRA be if they always see movement on my films? I can not breathe well lying flat due to my elevated diaphragm and obesity and COPD. One more question..... Could the TIA like symptoms be from low o2 sats when sleeping or high co2 levels???? Thanks!!
Brief Answer:
CTA is non-invasive.
Detailed Answer:
Thank you for getting back.
CT A or CT angiogram does not require any catheterization and wire placement. It just needs injection of contrast material in a vein near elbow.
MRA pictures would not be good if there are movements.
Low O2 can predispose to TIAs.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
CTA is non-invasive.
Detailed Answer:
Thank you for getting back.
CT A or CT angiogram does not require any catheterization and wire placement. It just needs injection of contrast material in a vein near elbow.
MRA pictures would not be good if there are movements.
Low O2 can predispose to TIAs.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Would a tia from low 02 be as dangerous as one from a blockage or small clot? Would a tia from high c02 or temporary low o2 be less likely to predispose one to a full blown stroke later on.
also... I am taking Excedrin Migraine 2 caps twice a day. Is this ok because of the asprin content? I also take .5 ativan for neuropathy and nerves. Would I be better served by taking midrin? I used it in the past and it helped.
One more.... I am on Diovan. I seem to remember that I had less problems when I was NOT on it. Any chance Diovan can cause migraines?
Thanks!!
also... I am taking Excedrin Migraine 2 caps twice a day. Is this ok because of the asprin content? I also take .5 ativan for neuropathy and nerves. Would I be better served by taking midrin? I used it in the past and it helped.
One more.... I am on Diovan. I seem to remember that I had less problems when I was NOT on it. Any chance Diovan can cause migraines?
Thanks!!
Brief Answer:
Low O2 alone would not cause TIA.
Detailed Answer:
Thank you for getting back.
Low O2 alone does not cause TIA, however, in combination with other risk factors, it may cause. So, treating low O2 and high CO2 would reduce the chances of getting TIAs.
Excedrin and ativan are fine and you may continue them.
Diovan is not known to increase the risk of TIAs, so, any worsening could be co-incidental.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Low O2 alone would not cause TIA.
Detailed Answer:
Thank you for getting back.
Low O2 alone does not cause TIA, however, in combination with other risk factors, it may cause. So, treating low O2 and high CO2 would reduce the chances of getting TIAs.
Excedrin and ativan are fine and you may continue them.
Diovan is not known to increase the risk of TIAs, so, any worsening could be co-incidental.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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