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What Causes Difficulty In Speech Along With High BP?
Question: My brother has yesterday high bp when measured it was at 170/100
In the evening his tongue start slipping and have problem in speaking.
Doctor suggested an MRI which indicate TINY GLIOTIC FOCUS IN THE LEFT HIGH FRONTAL LOBE PRE
CENTRAL GYRUS IN CORTICAL IN CORTICAL LOCATION LIKELY SEQUENCE OF PREVIOUS INSULT.
Remaining study was normal.
Normal diffusion no hemorrhage is seen
In the evening his tongue start slipping and have problem in speaking.
Doctor suggested an MRI which indicate TINY GLIOTIC FOCUS IN THE LEFT HIGH FRONTAL LOBE PRE
CENTRAL GYRUS IN CORTICAL IN CORTICAL LOCATION LIKELY SEQUENCE OF PREVIOUS INSULT.
Remaining study was normal.
Normal diffusion no hemorrhage is seen
Brief Answer:
Possibly of a transient ischemic attack
Detailed Answer:
Hi XXXXXXX
Thanks for being on HCM.
I am Dr.Ajay, a neurologist and I'd surely help you with your query.
I have seen report.
Your brother apparently had sudden onset dysarthria (Difficulty in speech) or probably aphasia which was associated with high blood pressure (170/100).
Please tell-
1) Did the speaking difficulty improve? If yes, in how much time?
2) Was this speech difficulty associated with arm or leg weakness? (If yes, did that recover too)?
3) Is there any history of similar complaint in the past?
If the complaints have improved and MRI including diffusion is normal (I would like to mention here that small old gliotic foci has no importance for this acute event), then it is most probably a 'transient ischemic event' and needs evaluation for the same.
Please reply with the questions I asked and I shall be able to guide you better.
Hope it helps.
Dr.Ajay Panwar
MD,DM(Neurology)
Possibly of a transient ischemic attack
Detailed Answer:
Hi XXXXXXX
Thanks for being on HCM.
I am Dr.Ajay, a neurologist and I'd surely help you with your query.
I have seen report.
Your brother apparently had sudden onset dysarthria (Difficulty in speech) or probably aphasia which was associated with high blood pressure (170/100).
Please tell-
1) Did the speaking difficulty improve? If yes, in how much time?
2) Was this speech difficulty associated with arm or leg weakness? (If yes, did that recover too)?
3) Is there any history of similar complaint in the past?
If the complaints have improved and MRI including diffusion is normal (I would like to mention here that small old gliotic foci has no importance for this acute event), then it is most probably a 'transient ischemic event' and needs evaluation for the same.
Please reply with the questions I asked and I shall be able to guide you better.
Hope it helps.
Dr.Ajay Panwar
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
As per my discussion with him
-There is still problem in speech which gets corrected on its own some time. BP is 140/100
-He has no weakness in hands and legs and he never witnessed it either earliar.
-He has no complaints of this type in the past.
Now the question is how to find out the problem and how to dignose it.
How to be certain that it is transient ischmeic attack and what caused it.
What precautions should be taken to prevent from such episode.
-There is still problem in speech which gets corrected on its own some time. BP is 140/100
-He has no weakness in hands and legs and he never witnessed it either earliar.
-He has no complaints of this type in the past.
Now the question is how to find out the problem and how to dignose it.
How to be certain that it is transient ischmeic attack and what caused it.
What precautions should be taken to prevent from such episode.
Brief Answer:
Still persisting speech difficulty rules out 'transient ischemic attack'.
Detailed Answer:
Hi XXXXXXX
Thanks for being in follow-up.
One day has passed and speech difficulty is still persisting.This is sufficient history to say that this is not a transient ischemic attack(TIA) as more than 95% of the TIA'S improve completely within 1 hour of the onset and the remaining few in the next few hours. Since, MRI even 'Diffusion' is normal, it is definite evidence to suggest that it is not a stroke. So, TIA and Stroke, both are ruled out.
There are following 3 conditions which could have caused his symptoms-
1) Alcohol intake
2) Anxiety
3) Some drug overdose.
All the 3 conditions can cause transient rise in BP and slurring of speech. If it is '1' or '3',the effects will gradually resolve, however some medicines will enhance the recovery.
If it is '2', anti-anxiety drug like 'clonazepam'(with a physician's consultation) will help in addition to some mental relaxation exercises.
But since MRI is normal(old gliotic lesion is not significant), it rules out most of the serious pathologies like stroke or multiple sclerosis.
Hope I have answered your query. If you still have follow-up questions, you are most welcome, else you can close the thread and rate it.
Dr.Ajay Panwar
MD,DM(Neurology)
Still persisting speech difficulty rules out 'transient ischemic attack'.
Detailed Answer:
Hi XXXXXXX
Thanks for being in follow-up.
One day has passed and speech difficulty is still persisting.This is sufficient history to say that this is not a transient ischemic attack(TIA) as more than 95% of the TIA'S improve completely within 1 hour of the onset and the remaining few in the next few hours. Since, MRI even 'Diffusion' is normal, it is definite evidence to suggest that it is not a stroke. So, TIA and Stroke, both are ruled out.
There are following 3 conditions which could have caused his symptoms-
1) Alcohol intake
2) Anxiety
3) Some drug overdose.
All the 3 conditions can cause transient rise in BP and slurring of speech. If it is '1' or '3',the effects will gradually resolve, however some medicines will enhance the recovery.
If it is '2', anti-anxiety drug like 'clonazepam'(with a physician's consultation) will help in addition to some mental relaxation exercises.
But since MRI is normal(old gliotic lesion is not significant), it rules out most of the serious pathologies like stroke or multiple sclerosis.
Hope I have answered your query. If you still have follow-up questions, you are most welcome, else you can close the thread and rate it.
Dr.Ajay Panwar
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Dear Dr
I am sending few reports which were conducted on the same day.
These are
-Lipid profile
-KFT
-Serum calcium level
-and routine urine report
Please go through them and give your suggestions.
Please also advice emergency BP medicine which could be used in such a episode if this occur in future.
I am sending few reports which were conducted on the same day.
These are
-Lipid profile
-KFT
-Serum calcium level
-and routine urine report
Please go through them and give your suggestions.
Please also advice emergency BP medicine which could be used in such a episode if this occur in future.
Brief Answer:
Though he has dyslipidemia,but it is not the apparent cause of this symptom
Detailed Answer:
Hi XXXXXXX
I Dr.Ajay Panwar,welcome you for the day.
I was expecting you to tell whether there was any association with any of the 3 conditions I mentioned.
I have gone through your brother's medical reports which suggest that he has dyslipidemia as his cholesterol is borderline high(208),triglycerides and VLDL are high.His dyslipidemia may be due to any of the following reasons:
1)Hereditary
2)Consuming excessive saturated fats and cholesterol
3) Less physical activity
4)Overweight
5)Alcohol intake
His serum potassium is borderline high which is almost normal and I advise to get it repeated.It is not associated with the present symptom.
His urine shows 1-2 pus cells and 1-2 epithelial cells which are normal.
With his current medical reports,he is not to be started on medications for his dyslipidemia. Rather,the following steps will help-
1)Losing weight
2)Physical exercise(jogging or cycling is the best)
3)Limiting saturated fats intake in diet.
4)Stop smoking or alcohol(if he does so).
5)Last and the most important is to eat the foods rich in omega-3 fatty acids as this will reduce both the Triglycerides and cholesterol.Examples of these foods are-chia seeds,hemp seeds,mustard oil,beans and green leafy vegetables.
His BP was 170/100,which is just the upper limit of what,which can be left alone without medicines and observed to settle down,if it is transient(short lived) and happens occasionaly(like once in a year).If BP goes more than that,medicines like amlodipine at the starting dose of 5 mg can be safely given(better is to take him to the physician and give medicine after his consultation only as sometimes,BP is too high say more than 190/110,then it has to be urgently lowered with intravenous medicines like labetalol.
Hope I have answered your queries.If still you have follow up questions,i shall be glad to help you,else you can close the thread and rate it.
Please write a review if you like the reply.You can also write a query directly to me at my HCM link-
http://doctor.healthcaremagic.com/doctors/dr-ajay-panwar/69273
Dr.Ajay Panwar,
MD,DM(Neurology)
Though he has dyslipidemia,but it is not the apparent cause of this symptom
Detailed Answer:
Hi XXXXXXX
I Dr.Ajay Panwar,welcome you for the day.
I was expecting you to tell whether there was any association with any of the 3 conditions I mentioned.
I have gone through your brother's medical reports which suggest that he has dyslipidemia as his cholesterol is borderline high(208),triglycerides and VLDL are high.His dyslipidemia may be due to any of the following reasons:
1)Hereditary
2)Consuming excessive saturated fats and cholesterol
3) Less physical activity
4)Overweight
5)Alcohol intake
His serum potassium is borderline high which is almost normal and I advise to get it repeated.It is not associated with the present symptom.
His urine shows 1-2 pus cells and 1-2 epithelial cells which are normal.
With his current medical reports,he is not to be started on medications for his dyslipidemia. Rather,the following steps will help-
1)Losing weight
2)Physical exercise(jogging or cycling is the best)
3)Limiting saturated fats intake in diet.
4)Stop smoking or alcohol(if he does so).
5)Last and the most important is to eat the foods rich in omega-3 fatty acids as this will reduce both the Triglycerides and cholesterol.Examples of these foods are-chia seeds,hemp seeds,mustard oil,beans and green leafy vegetables.
His BP was 170/100,which is just the upper limit of what,which can be left alone without medicines and observed to settle down,if it is transient(short lived) and happens occasionaly(like once in a year).If BP goes more than that,medicines like amlodipine at the starting dose of 5 mg can be safely given(better is to take him to the physician and give medicine after his consultation only as sometimes,BP is too high say more than 190/110,then it has to be urgently lowered with intravenous medicines like labetalol.
Hope I have answered your queries.If still you have follow up questions,i shall be glad to help you,else you can close the thread and rate it.
Please write a review if you like the reply.You can also write a query directly to me at my HCM link-
http://doctor.healthcaremagic.com/doctors/dr-ajay-panwar/69273
Dr.Ajay Panwar,
MD,DM(Neurology)
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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