Brief Answer:
TIA not a very good presumptive diagnosis in my opinion

Detailed Answer:
Hello ma'am. My name is Dr. Saghafi and I am a neurologist. I'm not sure why you're being told TIA's since you're pretty clear on the multiplicity of your events as well as the fact, that they are all stereotyped (i.e. same features or characteristics). You say that you've had every test run....but I would ask you to please elaborate exactly which tests have you had done. Have you had any labs done? The visual blurring is especially interesting as part of the entire mix in this picture. That symptom in and of itself has no relationship to any possible TIA which would involve the right side of the body.

Is there any slurring of speech, changes in your mental status (feeling a bit zoned out) during these episodes? Any headaches or piercing pains in the head when this is going on? Are you sure the MRI reports isn't talking about changes in the WHITE MATTER? Also, doesn't sound as if they've done any imaging study with gadolinium contrast which might not be a bad idea.

I'd be VERY CONCERNED if there were "changes in the gray matter"

So let's put it this way we're looking for some sort of process which first affected right face, right lip, right rear oral cavity, right arm, and right leg. Numbness but no weakness. Then, right eye started becoming distorted. Duration of these episodes is several minutes and there is absolutely no pain. BP is under control at this point and the episodes are multiple per day.

I think the differential diagnostic list has to look something like this and NOT NECESSARILY IN ANY PARTICULAR ORDER:

1.Metabolic derangements (eg. B12, TFT's, ANA, ESR, CRP, etc).
2. Atypical paroxysmal hemicrania (acephalgic variant)
3. Sensory seizures in the left sensory cortex or more radically, left brainstem epileptiform activity
4. Arteritis

My approach would be to redo the MRI of the brain and also do an MRA of the head and to do it with gadolinium contrast (check your renal function first using an EGFR). I would get fine cuts through the optic nerve on the right up to the chiasm. On the MRI you will need a diffusion/perfusion weighted study as well.

I would get a number of labs including ESR, CRP, TSH, FT4, Vit. B12, folate, Vit. D, D2, D3, ANA, Lupus Anticoagulant, fibrinogen, d-dimer, fibrin split products, RF

I would also consider an EEG

Of course, get a U/A, CBC w/diff, and Chem 20 if not already gotten.

In that workup must be the answer- You also need a really meticulous neurological examination by a neurologist interested in doing the exam twice if he can't find anything on you the first time....because there's gotta be something a little off that can be correlated to test results and diagnostic studies.

If this information has been helpful would you do me the favor of some written feedback and a STAR RATING of the answer? STAR RATINGS are very helpful to the physicians because folks pay a lot of attention to a doctor's rating by his patients when deciding to ask a specific question or return to him/her for service.

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bit.ly/drdariushsaghafi

This query has required 54 minutes of physician specific review, research, and final draft documentation for envoy to this patient.

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