I had a stroke like episode—what do I do?
Nitin K Sethi, MD
Assistant Professor of Neurology
New York-Presbyterian Hospital
Weill Cornell Medical Center
New York, NY 10065
I frequently see patients admitted to the hospital for evaluation of a suspected stroke like episode. Most of these patients are “normal” with no neurological signs and symptoms (the presenting symptom has invariably resolved by the time of their admission to an acute care facility).
So what are these stroke like episodes which scare patients and doctors alike leading to admission to a hospital and invariably a battery of tests including but not limited to MRI scans of the brain? Well some may be as vague as an episode of sudden dizziness, difficulty walking or weakness in the arms and legs, others are more restricted-an episode of difficulty speaking (I could speak but my words did not come out right or my speech was slurred as if I was drunk), loss of vision in an eye and so on.
When patients present to the ER or a doctor’s office with a history of such symptoms, they are frequently advised admission to rule out a possible stroke. When people think of stroke, they usually think of someone with weakness of the arm and leg but stroke signs and symptoms can be more subtle. Many patients have what we refer to as transient ischemic attacks (TIAs) prior to the stroke. As the name suggests, TIAs are transient (short lived) episodes of ischemia to the brain. Let me try to explain a TIA with the aid of an example. Let us assume a clot (entangled platelets and cholesterol crystals) breaks from the heart and goes up to the brain via the carotid artery (the carotid artery is one of the main arteries carrying blood to the brain). As it goes up further and further, it may get lodged in the ophthalmic artery (the ophthalmic artery is a branch of the carotid artery and supplies the retina of the eye). Now if the ophthalmic artery gets blocked by the clot there is no blood supply to the retina with resulting loss of vision in that eye (patients frequently complain of a black curtain descending in front of their eye). If the clot breaks by itself and dissolves the vision comes back (we call this transient monocular blindess—transient blindness in one eye). There you have suffered a transient ischemic episode.
There can be other types of TIAs which can involve different blood vessels in the brain and present with a myriad of signs and symptoms such as dizziness, double vision and difficulty speaking. So what is so important about TIAs?
Well put in simple language a TIA may be a warning sign of a future stroke (and by future, I mean in the NEAR future). It is a sign that all is NOT well with the blood vessels of the brain or the heart (either the vessels are slowing getting narrowed or the heart is not functioning well and throwing up small blood clots into the brain). TIAs thus should be aggressively and thoroughly investigated.
What are the stroke risk factors?
How can they be modified?
Does the patient need to be on any blood thinners?
As I frequently explain to my patients and their families
“A TIA IS A CRY OF THE BRAIN, A CRY FOR HELP
IF YOU DO NOT HEED IT IN TIME
YOU RISK HAVING A DEVASTATING STROKE IN THE NEAR FUTURE”
Braindisease's Weblog 
This is really good information! It is amazing that you are a doctor but can write in a way that all can understand. Thank you for what you do here on your blog.
Dear Merely me,
thank you for your words of encouragement. Hope you are well.
Personal Regards,
Nitin Sethi, MD
Dr Sethi,
Thank you so much for being available and offering your time and energy to people like myself! I was doing a little research, and found myself here. Thought I’d pick your brain 🙂
Over the past several years (2000 – present), I have had several “episodes”:
Numbness of right side of face.
Numbness of part of right hand and arm (the pinky and ring finger part).
Can’t see what I’m looking at (both eyes)…but still have peripheral vision.
Can’t talk. Trouble with coming up with simple words while trying to talk.
Can’t read…see letters, and how they form words, but can’t put it together.
All of these are, mainly, separate “episodes”. There are a couple of occasions where the blindness is followed by the inability to think of words or read. Each time, it only lasts a couple of hours or less. The numbness in my face was the first experience back in 2000, and hasn’t happened since. All other are reoccurring.
I am a 40 year old caucasian female in GOOD health. Mild atrial fibrillation, and one herniated disc in my neck (C4 or 5…can’t remember which). I recently quit smoking (after 25 years) and quit taking oral birth control at 35. No medications, no other health issues, no lasting impairments from said episodes. No family history of stroke. Have family history of heart disease, cancer, diabetes and MS.
I had a “numb arm episode” last week, was talking to my aunt about the different experiences I have, and she insisted that I see a doctor. The doctor says he thinks it may be TIA, and sent me to a neurologist. Neurologist recommended an MRI to rule out TIA and MS. Will be having an MRI within the next couple of weeks.
Here are my questions:
Is my history consistent with TIA?
Can a person be having TIA’s for as long as I have without a major stroke?
If so, do old TIA’s show up on MRI?
Thanks again for your time and consideration!
Dear Krista,
thank you for writing in. Transient ischemic attacks (TIAs) certainly remain in the differential diagnosis and it shall be prudent that you follow up with the neurologist since you do have some cerebrovascular risk factors. TIAs precede strokes and hence need to be evaluated for on an urgent if not emergency basis. TIAs may not show up on the MRI though there are reports that if the TIA is prolonged or “severe” the MRI shall document it. My very best to you.
Personal Regards,
Nitin K Sethi, MD
Hi
I have been reading on your site about tia’s which has been so informative and on a level that I understand.
I have a differential diagnosis. Neurology say that i have functional hemiparesis and rheumatology say seronegative antiphospholipid syndrome.
My inr is uncontrollable and ranges from high to low every day. When my inr is low as it rises i get nose bleeds, flashing lights, dizziness, numbness in my right side, slurred speech and then hemiparesis normally occurs.
My mri shows deepmatter white lesion on the left lobe as well as one in the subcortical.
Could both diagnosis be correct ?
Wishing you the best