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What Causes Severe Heaviness In Legs?
Question: My husband is 82 and has B12 injections every 8 weeks. A month ago he experienced severe feeling of heaviness in his legs, collapsed and lost some power of speech, though this returned in about 10 minutes. Taken to hospital, scans revealed no damage in the head or neck, in fact it was remarked that his arteries were in remarkably good condition; he has been presectibed statins, an anticoagulant and beta blockers. His bp is in the region of 150/62. He is due for a review in a couple of days. Does tis seems to be on track in typur opinion? I have cause to have some anxiety about the diagnostic skills in the hospital concerned...
Brief Answer:
A transient ischemic attack seems to be responsible.
Detailed Answer:
Hello!
Thank you for asking on HCM!
Regarding your concern, I would like to explain that your husband's clinical scenario (temporary loss of speech ability, altered consciousness, etc.) seems to be compatible with a cerebral TIA (transient ischemic attack).
A careful review of his overall clinical status is necessary. And the reason for Vit B12 injections??
TIA is unlikely to show any damage evidences on cerebral scans, and is primarily caused by a cardio-embolic event (which may originate from an unstable atherosclerotic plaque inside a certain blood vessel or from a cardiac embolic thrombus.
As his arteries are in remarkably good conditions, seems that the most probable explanation of this possible TIA event remain a cardio-embolic events.
Coming to this point, a comprehensive diagnostic work up is necessary to identify evidence of existent thrombus inside a left-sided cardiac chamber (most often a left atrial auricular thrombus), or any responsible cardiac arrhythmia like atrial fibrillation (which may predispose to cardio-embolic events).
Several cardiac examinations, beginning with a careful physical exam, a resting ECG, trans-thoracic cardiac ultrasound (to identify any structural heart implications predisposing to atrial fibrillation and thrombus formation) and if suspicions are raised trans-esophageal cardiac ultrasound (to identify a possible auricular thrombus), an ambulatory ECG monitoring (to identify a possible paroxysmal atrial fibrillation), are necessary.
Meanwhile, an optimal anti-coagulation and a rhythm control treatment are required to prevent any other possible similar events.
I think that the hospital team has decided the right diagnostic pathway and therapeutic decision.
I with that everything will be clarified by the ongoing diagnostic strategy.
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings! Dr. Iliri
A transient ischemic attack seems to be responsible.
Detailed Answer:
Hello!
Thank you for asking on HCM!
Regarding your concern, I would like to explain that your husband's clinical scenario (temporary loss of speech ability, altered consciousness, etc.) seems to be compatible with a cerebral TIA (transient ischemic attack).
A careful review of his overall clinical status is necessary. And the reason for Vit B12 injections??
TIA is unlikely to show any damage evidences on cerebral scans, and is primarily caused by a cardio-embolic event (which may originate from an unstable atherosclerotic plaque inside a certain blood vessel or from a cardiac embolic thrombus.
As his arteries are in remarkably good conditions, seems that the most probable explanation of this possible TIA event remain a cardio-embolic events.
Coming to this point, a comprehensive diagnostic work up is necessary to identify evidence of existent thrombus inside a left-sided cardiac chamber (most often a left atrial auricular thrombus), or any responsible cardiac arrhythmia like atrial fibrillation (which may predispose to cardio-embolic events).
Several cardiac examinations, beginning with a careful physical exam, a resting ECG, trans-thoracic cardiac ultrasound (to identify any structural heart implications predisposing to atrial fibrillation and thrombus formation) and if suspicions are raised trans-esophageal cardiac ultrasound (to identify a possible auricular thrombus), an ambulatory ECG monitoring (to identify a possible paroxysmal atrial fibrillation), are necessary.
Meanwhile, an optimal anti-coagulation and a rhythm control treatment are required to prevent any other possible similar events.
I think that the hospital team has decided the right diagnostic pathway and therapeutic decision.
I with that everything will be clarified by the ongoing diagnostic strategy.
Hope to have been helpful to you!
Feel free to ask me whenever you need! Greetings! Dr. Iliri
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
MANY THANKS FOR THIS HELPFUL ANSWER, DR SHARKA< The b12 unjections are for pernicious anaemia, diagnosed about 16 years ago and administered every 12 weeks until last April when increased to 8 weeks as he was beginning to have near-fainting spells a good month in advance of his usual presctipted time. This has been his only medication until a month ago, and he is is very good health, being currently in remission from bladder cancer in the last 5 years. Previously to the diagnosis of pernicious anaemia, he had been misdiagnosed for about 3 years with angina and treated for this, with debilitating effects which receded immediately once the B12 treatment began.
Brief Answer:
Blood Vit B12 level should be checked.
Detailed Answer:
Hi again, XXXX!
As your husband is taking Vit B12 due to pernicious anemia, it is important to check his blood Vit B12 level, as an insufficient level would lead to irreversible neurological changes.
The frequency of Vit B12 injections will depend by which prescription is being used (every month, or more rarely??).
Meanwhile, the above recommended diagnostic workup should be followed. You need to discuss with his attending cardiologist.
Best regards,
Dr. Iliri
Blood Vit B12 level should be checked.
Detailed Answer:
Hi again, XXXX!
As your husband is taking Vit B12 due to pernicious anemia, it is important to check his blood Vit B12 level, as an insufficient level would lead to irreversible neurological changes.
The frequency of Vit B12 injections will depend by which prescription is being used (every month, or more rarely??).
Meanwhile, the above recommended diagnostic workup should be followed. You need to discuss with his attending cardiologist.
Best regards,
Dr. Iliri
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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