Stroke symptoms in a relatively healthy person, 6 months after a major surgery
Posted , 3 users are following.
My dad, 54 years old, had a major lower back surgery in April 2016. He had slip disk surgery done on same location in 1997. In 2016 he allegedly lost much blood during surgery. End August 2016 he retired from his high pressure office job. September 2016, whilst still doing daily physiotherapy post surgery, he passed out in the bathroom for a few seconds or minutes in the morning. He went to hospital a few hours later and his bp was normal. Ensuing blood test says his Cholesterol was borderline and his haemoglobin is low. He did CT scan and they could not derive any problem from that. Middle December 2016 he had blurry vision upon waking up in the morning along with numbness of the left side of his body. Lasted just a few minutes as well. Again bp was normal and haemoglobin low and cholesterol borderline. He is scheduled for an MRI on monday.
Note prior to the 2016 episode he has no previous history of such conditions. He is very active, plays tennis once to twice weekly, and even competes regularly, he walks in mini marathons now-and-then. He is not overweight, does not smoke nor drink alcohol regularly. (Note we are in a small place with limited health facilites and health staff. A friend had a stroke recently and they were not competent in interpreting the MRI results. Healthcare is mostly reactive here. There are no neurological specialist per say here and for any further treatment, he will have to fly out of country to closest destination with such facilites 5 hrs away). I am trying to inform myself so as to decide on the next move we make so as not to waste the limited funds in hit and misses.
My questions:
1. What medical problem am i possibly looking at here? Is it a TIA? A GP dropped the term TIA on the table yesterday.
2. Could the surgery have anything to do with the symptoms he is having? As in could it be releasing blood clots in his blood stream?
3. Could the low heamoglobin and loss of blood suring surgery be the cause of be a contributory factor here.
4. What are the risks i am looking at for a possible flight out of coutry for further testing, diagnosis and treatment?
5. Any further critical questions i should really be asking?
Thank you kindly
0 likes, 8 replies
DoctorMark Mooneyto
Posted
I will answer your questions first.
1. You are looking at transient ischaemic attack (TIA) where blood carrying oxygen to the brain is being restricted. If left untreated I am sorry to say that a stroke is more likely.
During a TIA the patient will experience mild to severe stroke like symptoms. A TIA is pretty much a stroke but a lot less deadly. The cause must be identified ASAP.
2. The surgery can leave behind coagulated blood but this is usually just in the surrounding tissue. It is fairly unlikely that clots would be from the surgery but I will also say don't rule it out completely.
3. Hemoglobin is very important as it enables the red blood cells to carry oxygen. I would personally recommend that you check this regularly to see if it's going down, up or remaining steady.
Blood loss I would say is not a factor.
4. The risks are you will need to take that flight. During flight the cabin pressure is kept to that of about 8000 feet so there is a little bit less oxygen but sat still and relaxing the risks are very minimal.
Every now and the get up, stretch and walk (if he can)
5.ask your GP for a medical consult with a neurologists (even if it has to be over email or skype) and see if you can get some scans sent their way. You can even contact a specialist yourself and have scans emailed to them. A doctor be it a GP or specialist is there to help by all means reach out.
Right.. my personal opinion of your case is TIA. After reading your post it definitely sounds like a TIA. The patient sound healthy but is showing signs of possible stroke in the future so medical attention needs to be sought fairly soon.
A stroke can effect anyone, even non smokers are at risk especially as they age.
I hope this can help
Mark
Mooneyto DoctorMark
Posted
Dear Dr Mark,
I am very grateful for your detailed and informative reply and for your support. I will discuss with my dad and start taking some actions. I'll be back in the forum for further help. Once again thank you and many many blessings.
Christel
Mooneyto
Posted
I forgot to mention that since the first episode in September, dad has been on daily aspirin prescribed by the GP. The second episode occured while he was taking the aspirin on a daily basis. Please advise if this rules out/ or diminishes a clotting type of problem here.
I have also asked my dad to take some iron supplements twice daily along with some magnesium. He will also be trying some lemon in warm water on empty stomach to assist detox the liver in hope of assisting the liver with the Cholesterol regulation. Perhaps you can advise me on possible conflicts or contraindications with my cocktail!
I have also read about the effects of cayene pepper in detoxing the blood and stimulating the coronary arteries and widening the arteries. I also read that cayene pepper is a good first aid for cardiac complications. I am not entirely clear how the stroke problems link with cardiac problems but in my little mind i think it could help open up the arteries in the event of another episode. Perhaps you can help me clarify the difference or similarities between the two problems and share any knowledge about those alternative treatments.
Once again, thank you.
Christel
DoctorMark Mooneyto
Posted
Hello.
In the case of the aspirin use, it is used as a mild blood thinning agent, I imagine that this was prescribed to counter future attacks.
Obviously this has either not worked as planned or a new issue has arisen.
Vascular stenosis is not particularly common but in this case I wouldn't want to completely rule it out. Vascular Stenosis is the narrowing of arteries in the heart, brain, leg etc.. however, Carotid artery stenosis is where the blood vessels in the neck narrow causing stroke, loss of/blurry vision, speech and weakness. Because he is taking daily aspirin I would like to advise he gets tested for carotid artery stenosis. As mentioned it's not common but if ruled out we know the issue isn't something that can effect the brain AND heart.
Oh that's another thing... may I ask if your dad has had a recent ECG? (EKG in the US)
If so was it normal?
Regards
Mark
RHGB Mooneyto
Posted
DM, has answered most of your questions and I will add a couple of things from a layman's point of view.
There are two types of stroke (they can be sub-diveded), which are ischaemic - clotting and haemorrhagic - bleed on the brain. The rough split is 90/% to 10% with the mortality high with the haemorrhagic.
You can have mini strokes called TIAs Transient Ischaemic Attacks. These are virtually undetectable after the event and I don't believe a CT or MRI scan will pick these up.
Being fit does not really help you against strokes, there are other factors that play their part. In my case of my haemorrhagic stroke, is was high BP and a low platelet count (thin not coagulating blood) that caused it. For ischaemic/TIA it is pretty much the opposite, clotting blood and also high cholesterol that builds up plaque in the arteries, causing blockages.
If it was a TIA, they should be looking at blood thinners and lowering cholesterol. For cholesterol, they will probably want to use statins, but for me these are well known to have unpleasant side effects and I would prefer a diet change to using these, which is what I did.
Mooneyto RHGB
Posted
Thank you very much for taking time to assist me. Your reply is very informative and it sure helps me with getting a bigger picture to make decisions. Once again thank you and many many blessings.
Christel.
Mooneyto
Posted
In fact tou reminded me that dad is taking aspirin since the first episode and the second attack happened while taking daily aspirin. Perhaps him already being on blood thinner can mean that some possibilities can be eliminated and others asserted! Let me know if you have any further thoughts to spare.
Thanks again
Christel
RHGB Mooneyto
Posted
It's not quite that simple unfortunately and this is where doctors need to do tests to confirm.
There are Antiplatelet agents for atherosclerotic (aspirin)
Anticoagulation for cardioembolic (warfarin)
It may be that one will be more effective, depending on what type of event it was. The other thing to be looked at is the cholesterol, do you know what the level it was? Cholesterol particles such as plaque can break off and cause a TIA.
Not being a doctor, not having the patient in front of me and not having all the test results to hand, makes it nigh on impossible to say what the problem might be.
But if it were me, I would want to know whether they thought it was a clot or plaque that caused it. How have they decided on antiplatelet or anticoagulent for blood thinning. Whether they think the cholesterol was an issue and if so, what are they doing to tackle it. A platelet blood test to see if he has a high count and therefore at risk of clotting.
I don't usually recommend Wiki, but in this case, their page on TIA isn't too bad. Whatever you do, don't let them dismiss it as nothing. Many people who have TIAs have recurring ones.
I don't think they will find anything on the MRI because by its very nature a TIA doesn't really leave a foot print. Whereas my type of stroke- haemorrhagic - still leaves a big scar on the brain during a CT scan even two and a half years later.