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Transient Ischemic Attack

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I am hoping you can give me some insight about a certain health condition. I will list off the symptoms and scenario/background:

Over age 67
Going through lots of emotional stress
Lack of sleep
Evening just before bed.
Lying in bed
Sudden memory loss (forgot in mid sentence what he/she wanted to say)
Had hard time coming out with names, but no slurred speech or anything said wrong. Memory/confusion lasted less than a minute.
Suddenly, at the same time, a bit of frontal vision was blurred (both eyes or one eye I am not sure).
Later in the night had pain right above (brow) both eyes (like one would have with a sinus problem or a fever) and body aches like the flu.
Checked fever at night and temp was 98.3.
Eye pain/aches went away by morning. The eye pain above the eyes seemed to go away starting from left eye to right eye.
In the morning the vision was still blurred/not crisp/poor contrast/perhaps grayed? in same spot.
During the day vision seemed to clear up for about half an hour and then back again with the blur.
About 3250mg of Aspirin was taken during the course of 24 hours.
The next day the vision was still blurry in about the same spot I think but with lots of flashing lights on and off and christmas tree lights flashing as well as floaties - doesn't matter if eyes are open or not.
When the eyes are closed tight sometimes the flashing lights/colors would disappear for a little bit.
Something feels a bit different, can't describe it really, about the right eye, but the appearance looks normal as does the face.

Please let me know what you think all of this could mean. Underlying issues I might add are the following: Self-diagnosed PAD and irritable bowel syndrome.


Category: Neurologist, Medical

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Category: Pediatric Neurologist
Dr. Sudhir Kumar is online now

Expert:  Dr. Sudhir Kumar replied 4 Days.

Hi,

Thank you for posting your query at DoctorSpring.com. I have noted your symptoms and I appreciate your detailed description of symptoms. It was helpful.

Based on your symptoms, the most likely diagnosis is a minor stroke- TIA (transient ischemic attack), where the blood supply to a part of brain gets reduced for a short period of time. Aspirin is the drug of choice for this.

The other possibility is vascular headache, something similar to a migraine, where vision symptoms and headache could occur.

You need detailed evaluaiton, including a brain MRI and angiogram to confirm the diagnosis, and plan the best treatment.

I hope it helps. Please get back if you have any follow-up queries.

Best wishes,
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist


Patient replied :

In your experience have patients who experienced a mini-stroke also complain of flashing lights, flashing rainbow lights like a christmas tree and floaties after the stroke? Would a vitreous detachment be a more likely culprit than a mini-stroke or TIA? Does pain above the eyes like I described earlier go along with vitreous detachment? Furthermore, with vitreous detachment can the person take Aspirin on a daily basis without harmful side effects (ie. make it less prone to detach from retina properly)? One last thing, has stroke been known to trigger vitreous detachment? Please answer as detailed as possible. Thank you!


Expert:  Dr. Sudhir Kumar replied 3 Days.

Thank you for getting back.

I am sorry that I may not be able to give you detailed answers on vitreous detachment, as those cases are seen by ophthalmologist, and not a neurologist like me.

However, I agree that similar symptoms could occur with vitreous detachment. Vision loss in cases of vitreous detachment are more severe, as compared to your case. Aspirin is safe in cases of vitreous detachment, however, it should be avoided in patients with vitreous haemorrhage.

Best wishes, Would be glad to answer if you have any further queries.
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist


Patient replied :


Thank you for getting back.

I am sorry that I may not be able to give you detailed answers on vitreous detachment, as those cases are seen by ophthalmologist, and not a neurologist like me.

However, I agree that similar symptoms could occur with vitreous detachment. Vision loss in cases of vitreous detachment are more severe, as compared to your case. Aspirin is safe in cases of vitreous detachment, however, it should be avoided in patients with vitreous haemorrhage.

Best wishes, Would be glad to answer if you have any further queries.
Dr. Sudhir Kumar MD (Medicine), DM (Neurology)
Senior Consultant Neurologist

---
Additional Reply by Dr. Manish Malhotra, Consultant Ophthalmologist.

With these symptoms, posterior vitreous detachment or retinal detachment is a possible diagnosis. However the symptoms are not very specific or confirmatory for diagnosis. This photopsia and related symptoms can also occur in TIA , migraine with aura etc. The concern here is the short period of memory loss and name finding difficulty. A vitreous detachment in isolation should not cause any of these symptoms as it has got nothing to with the brain. On the other hand a TIA in the occipital lobe can cause all of these findings.

Neverthless you will require an opthalmic evaluation + CT/MRI scan of the brain. Till then I DO NOT recommend aspirin or other medications.

Hope this helps
Feel free to ask followup questions
Thank you


Expert:  Dr. Sudhir Kumar replied 2 Days.

I am not sure which doctor (perhaps more than one) should answer the following, but please read carefully and answer everything in detail. I am wondering why there are more floaters - does that go along with a TIA of the occipital lobe? I thought floaters are part of the eye and not produced by the brain. Do you know patients that had a sudden vitreous detachment and left them confused for a bit when it suddenly began (brain overload or what have you)? Furthermore, do you know of any patients who had a stroke trigger a vitreous detachment or can a stroke damage the eye itself? I am asking this because it seems like it's the eye itself having the problem (floaters), but then there is the possible brief time when couldn't get out names. Does a TIA occipital stroke permanently damage sight or does it often heal over time? And during the time after the possible stroke (days, weeks) will the person experience less and less flashes, colored lights, etc? Thank you very much for your time.


Patient replied :

Hello,

This consult has been reassigned to me :

"Do you know patients that had a sudden vitreous detachment and left them confused for a bit when it suddenly began (brain overload or what have you)? " - Yes, this is quite possible . There could be a lot non specific CNS symptoms , for which the cause is not well know. In your case my primary suspicion would be an opthalmologic problem like PVD. However an important aspect from a clinical point of view NOT to restrict the diagnosis only to the eye alone and keep the diagnostic possibility of TIA in mind.

In a real clinical scenario this will evolve like this - patient presents with symptoms - I do a quick Opthalmologic examination - Suggestive of PVD or Not. If an ophthalmologic diagnosis is confirmed I would not consider TIA --> proceed with PVD approach. But in the other I would consider the diagnosis of TIA. Floaters as you rightly said is more diagnosis of an eye problem. But again this is a subjective phenomenon and I would not risk a diagnosis just based on this alone.

The interesting thing is that there is a good chance that in the end after all evaluation there might not a Vitreous detachment or TIA and the cause could remain as a undiagnosed mystery.

I understand you are trying a symptom analysis for a definitive diagnosis , but without a physical examination it is really difficult to proceed.

Hope this helps
Thank you
Dr. Manish Malhotra.


Expert:  Dr. Sudhir Kumar replied 1 Day.

Thank you for all your answers. A few other things: Is it possible to mistakenly think there is a problem (such as a PVD) in both eyes when it's only one eye with the problem? With a stroke, is it possible for the greyed out area to go away (seemingly) at times, or seem like it's moving around a little bit? Is it normal for either or both PVD and TIA for a person to close their eyes, look toward the sun and see all red, but a bright white spot where the so-called greyed out area is? One last thing, do you know of anyone who had a TIA that triggered a PVD? Please answer each question in as much detail as possible and thank you very much.


Dr. Sudhir Kumar
Category: Pediatric Neurologist
Experience: 
Senior Residency, Fellowship: DM, Neurology, CMC, Vellore, 2001
Junior Residency: MD, Internal Medicine, CMC, Vellore, 1998
Medical School: MBBS, Christian Medical College, Vellore, 1995
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