multi TIA's

Hi, and thanks, I have already, as you suggested made a further appointment and will keep trying to find answers

Hi, Joanne, I am already on certain meds, at present, it seems I do not have arterial fibrillation and so my meds at present are amlodopine and aspirin, my Hubby has found that maybe I should also be on dipyridomole alongside the aspirin, anyway will see the doc again to discuss further. wish you well and thanks

Atrial fibrillation isn't a ridk factor for a primary cerebral haemorrhage or Sub arachnoid haemorrhage. If a haemorrhage occurs as a result of an ischaemic stroke ( dying/damaged brain cells then go on to bleed) caused by a clot or fatty plaque then AF would be a risk factor for the original event. This may be the case as carol says she's on Aspirin.

You would only need to be on Clopigogrel and Aspirin if you were on Aspirin already at the time of the stroke. Even then, as you had a brain haemorrhage, I'm not sure they would put ypu on two blood thinners, and Clopidogrel does have a higher chance of causing bleeding than Aspirin, which is why they only use it in higher risk people and those who can't take Aspirin/

.

Hi Aneta, thanks for your response, good advise, and now that I am talking about it, I do feel a little more relaxed

Hi, Winnie, I tried 'behind the gray' at your suggestion, but it seems specifically for SAH, rather than my TIA's, that said, very helpful and I thank you for taking the trouble to help me.

I love chocs too, scrummy! I really wish you luck, SAH makes my TIA's seem trivial

Thanks Misswoosie, interesting! I did have a scan, in fact two scans so far, each organised by the memory clinic, and they say that the scans show multi TIA,s ? so I am confused. I have never experienced problems with face or body and so there is no evidence that I suffered stroke.

In terms of the National Stroke guidlines, well this is really where it falls apart, I am still waiting for an appointment to see a consultant and it seems that it will be several weeks/months before I get to see anyone.

​But thanks for your response, regards

Hi Carol,

Can I ask why you've had 2 scans?

Was it because you have memory problems? Someone here mentioned vascular dementia , but  I don't see that you say you have that, only that you've been seen at a memory clinic.

If you were referred to the memory clinic by your GP, what happened prior to that?

TIA's definitely don't show up on CT scans. The clue's in the name, as I said before. T is for transient, ie the symptoms come and go, and there is no residual damage to the brain.

A small stroke, however, would show up on a CT scan (eventually).When the brain cells are starved of oxygen as a result of the disruption in the blood flow, some of the cells die and this area of dead cells (the infarct) shows on a scan.In a TIA they're not starved of oxygen for long enough to cause brain cells to die

Some strokes don't cause weakness problems. It depends where in the brain is affected. It can be less commonly known symptoms, such as memory, vision, understanding speech and finding the right words, and the very subtle things like balance,falling about, judging distances, having problems doing things that , prior to the stroke, you wouldn't think twice about. A reason for the dleay in you being seen might be because the stroke consultant to whom they've referred you doesn't think they're TIAs or strokes. Don't suppose they said where in the brain these TIAs were? I know it's pretty unbelievable, but soem Doctors do still insist in calling small strokes TIAs, when in fact they're not, although essentially the follow up and secondary prevention are the same. Hope you get the care you need soon. NHS is going to the dogs and has been for the last 15 years. Too many Doctors and GPs compared to nurses and support staff. Glad I'm out of it and living it up on my £400 per month pension (taken early) ater 28 years of service.

Hi, thanks again for your input, very interesting.

​I have got vascular something or other, but not at present vascular dementia, the report from the CT scan says :-  'Small cerebellar, subcortical hypodense areaof lacunar infarct. There is also a smallestablished rightcerebellar infarction seen along the superior cortex of the right cerebellar hemisphere. Small left frontal periventricular lacunar infarct'. now, I have typed all of that, not a clue what it means.

​Your comment regarding delay in being seen :- I am still at the stage of 'choose and book' ie there is no consultant involved at present, just can't get a resonable date from any hospital ther than maybe 2 months waiting time.  Regards

PS   I am told that all this wording means multi TIA's is that not true?. And yes, retirement is great!

Hi Carol,it's my impression ,from the use of the word "infarct" that the CT scan shows 3 small strokes, ie infarcts. I'm not a Doctor, but I worked as a Stroke Clinical Nurse Specialist, Anticoagulant.Deep Vein Thrombosis Nurse Specialist and then Clinical Lecturer Practitioner in acute stroke for 10 years. Google Gary Ford Stroke. In the late 90s I worked at Freeman Hospital with him and together we set up the FIRST ever UK stroke thrombolysis service. Latterly I worked with Chris Price, Stroke consultant at Northumbria Healthcare and Lecturer at Newcastle University. As you can imagine I've looked at and read CT reports for 1,000s of CT scans for Stroke and TIA patients and I'm (although retired) extremely passionate about stroke and TIA patients getting the right care at the right time.  I am not sure who is saying they're TIAs, but they need a knock on the head.

I don't know the date of this scan, but it looks like one of the strokes "Small cerebellar, subcortical hypodense areaof lacunar infarct" is more recent. They are all small strokes and I wouldn't expect that when they occured any of them would've caused loss of movement of any limbs or anything else which most people associate with stroke. So, you (and the wonderful Doctors) may have missed them, but maybe you have some symptoms that they have classified as memory problems and diagnosed as vascular something. Do you live alone? Have you had any falls or trauma to your neck recently?

The referral should be as per the local guidelines for the TIA /Stroke referral protocol and shouldn't go anywhere near bleep Choose and book, but be faxed directly to the Stroke Consultants secretary. I might be able to help you if you can tell me where you are, or you can call yiur GP, tell them you have had a CT scan that shows you;ve had several small strokes and they need to send a referral directly to the Acute Stroke Service Do you know which acute hospital trust you fall under? It should be on the Letterhead of any letters you've recieved. We need to try and make sure you get the investigations and care you need.

Hi,

Sorry to jump in here. But I have my patient records from my hospital stay, along with CD images of my CT scan, but there is no copy of any readout or report from my scan. There are some handwritten comments in my what I would call bedside notes, but nothing that could even be vaguely called a direct report from the CT scan.

Should one exist and do I need to go back and ask? I always thought it funny that there was nothing specific from it. Even my ECG at the time mentioned infarct - I know that is for a different part of the body, and relates to a different phenomenon.

Hi, very informative yet again and thanks, I am now very much more enlightened.

​The answers to your questions :- I live with my hubby, who incidentally helps me to compose these emails. No falls, but I do have sever osteoarthritis in my neck and elsewhere, and I come under Walsall, West Midlands, the Manor.

​I have been back to the doctors and have asked them to send a referral  letter direct to the stroke clinic at Manor hospital Walsall, but, whilst they have agreed to do this for me, they say that the 'choose and book' request is already at the Manor and that it is doubtfull that the referral letter will get any better response.

​Thank you so much, you have been a great help to me.  Regards  Carol

Hi Carol,

Here's the link for the Acute stroke service page for Manor Wallsall.

https://www.walsallhealthcare.nhs.uk/acute-stroke.aspx

It won't come up as a clickable link here, but you can copy and paste it into your web browser address bar , right up at the top left, where it will currently say "patient.info/forums...... I found it by googling "manor wallsall stroke service". As you can see, they have TIA clinics every morning and GP's can refer you directly to the service via the hospital switchboard.

If you've had 2 CT scans then not sure why (if the first one showed an infarct (s) you weren't referred then, and why after the second CT scan, the memory clinic didn't refer you straight away. I know this is difficult enough for you, but I would strongly consider making a complaint. Perhaps you have a son or daughter who can support you in this if you and your husband don't feel up to it. Please let me know how you get on. Best Wishes, Susan

Hi,

I'm assuming that things were prety crazy when you went into hospital with your SAH? The Docs were probably given a verbal report on your scan by the radiologist, or they , as neurosurgeons would be very capable of interpreting it. This is probably "the scribble" in your notes. Nowadays, Docs can log into the Xray system and read the formal report that's written by a radiologist ( a Doctor who specialises in all aspects of Xray and scans). There should also be a printed copy of this official report stuck in your notes, usually on a separate page with other X-ray and scan results. Clinically nowadays a SAH isn't classified as a stroke, as it doesn't have the same risk factors,or require the same treatment. Likewise they don't require the same intervention to prevent another. Usually SAH are caused by a rupture of an artery where there was a congenital ( present at birth) weakness,unless of course they occur because of a bang to the head. They tend to run in families and are most common in middle aged women.

A myocardial infarct ( heart attack) would show up on an ECG.

'I'm assuming that things were pretty crazy when you went into hospital with your SAH?'

Yes and no, it wasn't what I was sent in for, even though I thought it was the reason my GP sent me straight to A&E whilst ringing up the hospital to speak to the bed manager.

If you're interested, I'll explain tomorrow, in a bit more detail. I accept your understanding of an SAH, although it was ICH which I think is slightly different. Size 2.2 x 4.0 x 3.5cm and a 6mm midline shift for good measure. It was a rupture of an artery caused by unchecked hyperension with other circumstances, no family history and I'm definitely male - there is still ongoing discussion about whether trauma played its part.

The ECG says; Consider anteroseptal infarct.

I've a gastroscopy at nine in the morning tomorrow (which should indicate there were other problems) and I'll repost tomorrow if necessary.

Sorry, I thought you said you'd had a SAH. Yes, an intracerebral haemorrhage is different as the bleeding is inside the cerebral tissue. A SAH occurs outside the brain tissue. Nasty, especially with all that midline shift.

Consider anteroseptal infarct means that whoever reported on the ECG thought there was a possibilty that you'd had a heart attack. Good Luck tomorrow.

My apologies if I used the wrong terminology, I though bleed on the brain could refer to either ICH or SAH, it then just depended or where the bleed was that decided which one it was.

Warwick hospital that orginally had me for the first 12 hours, have now said (through PALS) that they are not sure and for me to contact Coventry (PALS) as to the exact nature of the stroke, which I find strange as they were the ones that did the CT and diagnosed me. I didn't get the radiologist report with my patient records and I have now asked Warwick (PALS) to provide it (especially as I had to pay £25 for my records for a 12 hour stay).

I have also asked for more info on the infarct ref ECG, as there is no follow up on that. I would have thought at some stage someone would have checked up on it and even if it was nothing, they would have written that into my notes. I think I am not their favourite person now. I am always polite, and I don't know why my records shouldn't state clearly about the stroke and that soem followed up the ECG even if just to confirm it was negative.

On the positive side, the gastroscopy was a walk in the park and it said that my oesophageal varicies have gone.

Hi, what exactly are you complaining about via PALS? It seems that you know that you had a Primary ICH and what  caused it

"Size 2.2 x 4.0 x 3.5cm and a 6mm midline shift for good measure. It was a rupture of an artery caused by unchecked hyperension with other circumstances, "

That is my understanding from reading the notes. I have never been told much. I have asked the hospital to confirm that it was in fact a stroke, as opposed to a trauma to the head. They have come back and told me they can't tell me (they don't know) and have suggested that I contact the hospital that I was transferred to, even though the first hospital did the CT and the radiologists report has not been included.

The stroke rehab hospital say that it wasn't a stroke and asked crass questions like, did you have a fight the night before. I have pointed out that nowhere in my notes, X-rays or CT scan does it show signs of trauma. Which is why I wanted a chat with a doctor to go through it. I may not be medically qualified, but I have held fairly senior management psoitions and I know how you present the facts.

To give you an idea of the sort of things they have omitted to mention, a blood plasma transfusion, even though I am down as alert and orientated in my notes, nor was it communicated to my wife. I ony found out later by accident when the gastro was worried about my bloods and was contemplating a cancer marker test and asked me if I'd ever had a blood transfusion, to which I was about to say no, when he said, of course you have, we gave you one here. I'm sure they're meant to ask the patient or next of kin (who was in constant contact with the hospital) for permission before they do that sort of thing.

There are so many things I have not been told, more than I have mentioned here. I just feel, that it is important to know whether it was a stroke or trauma that caused a bleed on the brain and also, if by some small chaance I suffered a minor heart attack at some time, I feel that that is also important to know.

I haven't complained to anyone, I asked PALS for their help after purchasing my patient records. The fact that I have asked for the radiologist's report and what was the follow up if any about the ECG, I think has mildly irrated them, but I thought that was what they were there for.

My file on the gastro side, seems to have got put aside, because the gastro left and no one ever looked at it. The follow up on possible haemochromatosis was not done, I found out about the cancer test by accident and had to write in and ask for the result. The liver US, OGF and repeat bloods were never done. It was only when I got my patient records a couple of months ago, I started to find out things like this. Then had to get an appointment and ask for the long overdue tests to be done.

I am not complaining, I am merely asking people for answers, answers to what I think are fair questions.

Sorry, I;m a little confused. Surely you would know if you had been subject to any trauma to your head before the haemarrhage happened. If there was no trauma then why are they saying it may have been caused by trauma? In the notes, in the medical examination, does it say "signs of trauma to the head" ie bleeding, a big lump" If there was no trauma then it was a spontaneous Intracerebral haemorrhage. Did you go into hospital with problems with bleeding from your GI tract, or problems associated with your liver?

If you're in hospital, then you are consenting to certain treatments, otherwise what would be the point of you being there? If you were in intensive care then you're consenting to treatments commonly associated with intensive care. If you were unwell, which it sounds like you were, and perhaps you were beeding, and your clotting factors were reduced,or your protein and albumin levels were low, then giving you a plasma infusion could have been classed as life saving and would not have required formal consent. I can see and appreciate that things may not have been done, and sometimes medical professionals aren't wholly non-discriminatory of certain groups of people. For example, my GP discriminates against me because of my age (post menopausal), history of "depression" and  ex senior nurse status. Basicaly she things I'm either mad or a Hypochondriac or both! Others recently have been the same ( we;ve moved twice since returning from the USA and had to change GPs since ). It disgusts me that they won't even take a proper history and do a clinical examination. Nurse Practitioners could do a better job for a quater of the salary of a GP.

I would try to get the notes from the hospital where you attanded A/E (I assume).

If I sometimes mis spell or my grammar is incorrect then I apologise. I have my own health problems for which I've had to pay for private bloods, and tring to get those sorted.

The short answer. I was sent to A&E by my GP for jaundice and possible liver failure (ALD). But what I actually went to see him for was nausea, ataxia in the legs and complete loss of balance.

When I got to the hospital and had the CT scan, I was diagnosed with the blled on the brain. I did have two falls, but they were down to me completely losing balance and loss of the use of my legs. But the hospital and the next one seem to have decided I was a drunk that fell over.

This is depsite the fact that there were no signs of trauma, no bruises, bumps or pain from the edxterior of the head. I have both Pt records from each hospital, and there is nothing in them about actual evidence of trauma documented on any of my notes.

I think that it makes a difference to the outcome of future events/my health as to which it was. And I'm surprised that they just decided on this option without evidence, especially as I had uncontrolled hypertensions for decades and was a heavy drinker, both well know causes of spontaneous Intracerebral haemorrhage.

I have had a reply back from the first hospital, having had the neuro consultant look back through my notes and unsurprisingly, he cannot be sure and has advised me to contact the second hospital. I suspect the second hospital is going to try and say they followed the lead from the first hospital. Because there is no record in my notes that mentions indications of trauma.

And no, other than on my brain, I was not bleeding, either externally or internally.