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Q: Stroke? What Next?
asked by: jkrishna on September 27th, 2006
New User
Background:
last sunday(9/17), my father suddenly felt a numbness on the right side of his body - his mouth felt a kind of "pull", and though he did not lose mobility, he found it difficult to sign. My mother immediately gave him an aspirin and took him to a doctor, who diagonized it as tia. However, the symptoms did not completely disappear in 24hrs (which I believe happens with a tia).
It is now almost 10 days since. The 'pull' in his mouth is almost gone, but he still has difficulty signing - cant sign more than twice continuously. He was able to drive, two days after, though he avoids it as far as possible.

He met a neurosurgeon the next day who advised him to undergo a suite of tests. Here are some of the results.

Test results:
ecg: aortic valve sclerotic
homocysteine: 65 (recommended <13)
ct scan: focal low attenuation in the left thalamus. Also shows a small dot in his brain, which the doctor refered to as 'scar'. This, according to the doctor, is in a place that controls motory actions, and so the difficulty signing.
Mri: my father felt an excruciating pain in his neck when he was strapped, and also felt claustrophobic, so refused to take an mri.
Doppler test: nothing unusual

lifestyle & history
my father does not smoke or drink and is a vegetarian. He is 58 and has had high blood pressure for the last 20 years or so,controlled by medicaiton. Diet is fairly balanced. He smoked for about 5-6 yrs but stopped about 30 yrs back. Works in a desk job, and doesn't exercise much. He drinks about 5-8 cups (150ml each) of coffee a day. He had a similar numbness on the right side about 10 yrs back, but tests then did not show anything.

Doctor's diagnosis:
according to the neuro-surgeon, the high level of homocysteine was the cause of a very minor stroke. He has prescribed vitamin b and folic acid tablets, and plagril (a pill containing aspirin) for life.

My questions:
is the diagnonsis conclusive enough? From what I read on the net, it is not clear whether high levels of homocysteine is a cause or a symptom or a fall out of a stroke!
What is the risk of another stroke? The doctor says it won't happen since he's now on aspirin for life.
He has frequent ulcers in his mouth, especially when he eats out. Is it ok for him to be on aspirin?
What is the risk of any heart/other ailment, given this information or background?
He has now started walking 30 min a day and is trying to cut down on coffee. Is this good/sufficient?
Are there any other tests he should undergo, which might reveal more?
Is it ok for him to start driving so soon?
Appreciate your advise!
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Replies(3)
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JUNGLE JUICE
replied on September 27th, 2006
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Blimey
To deep 4 me sorry xgood luck though.
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jkrishna
replied on September 27th, 2006
New User
Thanks for replying anyways!
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drdgb
replied on January 2nd, 2007
New User
Hi,

an event that shows up on ct is unlikely to be tia so he did have a stroke. A stroke in the left thalamus would cause the symptoms you describe. I think the diagnosis is fairly clearcut here. An mri with diffusion weighting would have proven that there was a brand new stroke there.

Homocysteine is becoming more recognised as a cause of "vascular disease" (stroke and heart disease) but it is not as important as the other causes (blood pressure, high cholesterol low hdl, high ldl, diabetes, smkking). Your father needs all of there monitered and treated. He must stay off cigarettes and stay on the aspirin.

The aspirin will not afffect mouth ulcers but can cause stomach irritation/ulcers and there is a tiny risk of stomach bleeding. Watch out for stomach pain or heartburn - he may need a stomach-protecting drug.

That level of exercise is fine, he can probably drive, coffee is probably not going to affect his risk.

He has a marginally higher risk of another stroke and heart disease having had this event. The risk is minimised by treating all the risk factors I mentioned.

I assume he had an echocardiogram if you say he has aortic sclerosis. Did he have a holter also?
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