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Having consistent seizure or a form of stroke. Normal with aging? Treatment?

Nov 2013
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Practicing since : 1994
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Hello. I am a 47 year old women, normal weight, blood pressure, do not smoke, and generally healthy. About a week and half ago, I woke up in my bedroom at my home and did not recognize where I was and I had trouble speaking and following conversation. I could not recall the days before or specifics from the past week and could only recall some images. I also could not recall other major events from the past year. I went to the ER and had an MRI completed and was diagnosed with transient memory loss and referred to a neurologist. Neurologist scheduled me for an EEG in 2 days for fragmented memory loss and partial seizure vs psychogenic phenomna. Below are the MRI results: FINDINGS: There is no evidence of acute intracranial hemorrhage, infarction, mass effect or midline shift. No abnormal extra cranial fluid collection is identified. The ventricles, sulci and basilar cisterns are normal. There are a few tiny scattered areas of subcortical and periventricular white matter T2 hyperintensity, particularly in the parietal lobes, consistent with chronic small vessel ischemic disease.
The flow voids of the skull base are unremarkable. The visualized paranasal sinuses, mastoid air cells and orbits are normal. The skull base and calvarium are intact. IMPRESSION: 1. No acute intracranial pathology.
2. A few scatted white matter lesions in both parietal lobes most consistent with chronic small vessel ischemic disease. Vasculitis and demyelinating disease could have a similar appearance, and these are clinical possibilities.
My family told me that the day before I slept most of the day and seemed normal.
Since going to the ER, I have been able to recall some of my memory which required a lot of focus and tired me. I am also having trouble focusing and following and do not feel that my cognitive abilities are normal. And I am more tired than normal I have also experienced additional memory loss since the initial incident.
About 2 months ago, I experienced severe headaches that would last for days and had a swollen lymph gland behind my left hear. So went to the doctor ordered CT with no issues.
Before ordering the EEG, the neurologist made reference to a potential seizure and that the EEG would help with providing additional data for diagnosis. MY QUESTION: FROM THE DATA THAT I PROVIDED ABOVE, IS IT CONSISTENT WITH A SEIZURE OR A FORM OF STROKE OR IS THIS JUST NORMAL AGING. WHAT SHOULD I EXPECT NEXT IN MY JOURNEY OF GETTING A DIAGNOSIS AND WHAT ARE TYPICAL TREATMENTS?
Posted Tue, 4 Jun 2013 in Brain and Spine
Answered by Dr. Sudhir Kumar 1 hour later

Thank you for posting your query. I appreciate the detailed description provided by you, as it helps a lot.

I agree with your neurologist that the two possibilities in your case include minor brain stroke or a seizure. I would consider stroke as the first possibility. The kind of stroke thst would lead to memory loss as in your case would be transient global amnesia (TGA), a form of transient ischemic attack (TIA), also called as minor brain stroke.

The MRI brain shows features of ischemia (lack of blood flow to brain).

Further investigations would include finding out the risk factors for stroke such as high BP, high sugar, cholesterol or homocysteine. Carotid doppler and echocardiogram are also advisable.

Medications would include aspirin and statins. Anti seizure medications may be given empirically for some time.

I hope it helps. Please get back if you have any more queries.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad
Above answer was peer-reviewed by
Follow-up: Having consistent seizure or a form of stroke. Normal with aging? Treatment? 41 minutes later
Can you clarify is the term "transient global amnesia" a type of a brain stroke? Also is it normal after having such a thing that t I have not returned yet to feeling normal? How long should it take until I feel 100 %?

Thank you for your assistance.
Answered by Dr. Sudhir Kumar 13 minutes later
Thank you for getting back.

TGA (transient global ischemia) refers to a type of brain stroke (lack of blood flow to the brain) where the predominant symptom is memory impairment, and the person recovers within or after a few hours to a few days.

I am sure you would completely recover, as there are no acute infarcts on the MRI, suggesting that there is no permanent tissue damage in brain.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
Follow-up: Having consistent seizure or a form of stroke. Normal with aging? Treatment? 23 minutes later

Sorry to bug you more.

When can I expect to feel normal again with respect to memory and energy?

Why is the EEG needed?

Also, I attached the results of my blood work. Do you see any red flags for risk factors? (e.g., high sugar, cholesterol or homocysteine).

Thank you!!
Answered by Dr. Sudhir Kumar 41 minutes later
Thank you for getting back.

You would feel better with respect to memory and energy in a week or two.

EEG may help in diagnosing a seizure disorder.

I do not see any attachment here. May be you can upload them again.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
Follow-up: Having consistent seizure or a form of stroke. Normal with aging? Treatment? 1 hour later
Dr. XXXXXXX I am unable to determine how to add the file to this message. However, I was able to upload the files to the XXXXXXX website under my profile. I have also included them below for your review.

I greatly appreciate your assistance. You have helped me significantly to better understand. I am looking forward to identifying my risk factors so I can avoid this situation in the future.

Thank you again!!

Component Results
Component     Your Value     Standard Range     Units
WBC     5.9     4.8 - 10.8     10^3/uL
RBC     4.46     4.10 - 5.30     10^6/uL
Hemoglobin     13.1     12.0 - 16.0     gm/dl
Hematocrit     39.5     37.0 - 47.0     %
MCV     88.6     81.0 - 99.0     fl
MCH     29.4     28.0 - 32.0     pg
MCHC     33.2     32.0 - 36.0     g/dL
Platelets     269     150 - 350     10^3/uL
MPV     11.2     7.4 - 10.4     
Neutrophils Relative     58.0     50 - 70     %
Lymphocytes Relative     31.5     20 - 40     %
Monocytes Relative     9.4     2 - 11     %
Eosinophils Relative     0.5     1 - 3     %
Basophils Relative     0.3     0 - 1     %
Immature Granulocytes Percent     0.3     0 - 0.4     %
Neutrophils Absolute     3.4     1.8 - 7.7     10^3/uL
Lymphocytes Absolute     1.9     1.0 - 4.8     10^3/uL
Monocytes Absolute     0.6     0.1 - 1.4     10^3/uL
Eosinophils Absolute     0.03     0.0 - 0.3     10^3/uL
Basophils Absolute     0.02     0 - 0.2     10^3/uL
Immature Granulocytes Absolute     0.02     0 - 0.03     10^3/uL
RDW     15.5     <16.5


Component Results
Component     Your Value     Standard Range     Units
BUN      17     5 - 25     mg/dl
Sodium     140     135 - 146     mmols/L
Potassium, Bld     4.7     3.2 - 5.0     mmols/L
Chloride     104     95 - 112     mmols/L
CO2     34     18 - 32     mmols/l
Glucose, Bld     98     70 - 115     mg/dl
Creatinine     0.7     0.5 - 1.5     mg/dl
Calcium     9.6     8.1 - 10.2     mg/dl
Anion Gap     3.00     5 - 20     
Glom Filt Rate, Est     > 60     >60     
GFR MDRD Af Amer     > 60     >60
Answered by Dr. Sudhir Kumar 6 hours later
Thank you for sending the blood reports.

They are all normal here. Among the risk factors for stroke, I found only blood sugar values here, which are normal.

So, if you have lipid profile (cholesterol) and homocysteine values, please send them too. If they have not been done, please get them done.

Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
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