Brief Answer:
CT scans cannot SHOW a TIA

Detailed Answer:
Good afternoon. I am an adult neurologist and would like to provide some input on your question. TIA stands for Transient Ischemic Attack which can also be referred to as a "mini-stroke." However, the definition of TIA is a sudden onset of neurological dysfunction for which the patient completely resolves within a short period of time (24 hrs. is used as a common marker though we believe it to be much shorter than that). From a clinical perspective an examination after they have gotten back to base line would show no problem whatsoever as opposed to a STROKE which after the 24hr. timeline would still show some neurological deficit (e.g. weakness, numbness/tingling, inability to speak or comprehend normally, etc.).

The CT scan of the head is one of the LEAST sensitive studies that can be used in this setting but it is adequate in the sense that it can rule out things such as bleeds from aneurysms, large tumors that could be mimicking strokes, or infections/abscesses that could be pressing on structures and again causing neurological problems. But under no circumstance can a neurologist or radiologist simply look at a CT scan and make a diagnosis of TIA.

The CT in your case was probably read as NORMAL by the radiologist, no evidence of acute infarction, no evidence of intracranial bleeding, no evidence of swelling or edema of the brain, no evidence of tumors, etc.

Your blood pressure of 145/70 is not excessively high but it is a bit higher than allowed by modern parameters as far as the 1st number (the numerator is concerned...the systolic pressure). However, if this is the first blood pressure you've gotten in a long time and especially if this were done at the time you presented to the hospital or doctor's office then, I would disagreement with any decision to either make a diagnosis of hypertension or give any prescriptions to lower blood pressure. In fact, if the treating physician truly believed that your symptoms and presentation were entirely consistent with a sudden neurological deficit that improved (i.e. TIA) then, giving you anything to lower your blood pressure without having done a full workup to discover WHY you may have had the TIA is a potential risk to the patient. If it were me facing such a patient I would not likely prescribe anything to lower blood pressure of 145/70. If pressures were ridiculously high in the 170's-180's or higher or if the diastolics were also highly elevated in the 100's and such then, yes I would treat but probably try and convince the patient to stay for some observation...even if in the ER as opposed to giving them anything and letting them go home.

That is my UNSOLICITED opinion on your situation of TIA and how it was handled.

Now, to your direct question of Mobic + Perindopril- There are 2 interactions that we mostly worry about with those 2 medications. I will just copy them here for you to review. I would advise that you check back with the doctor who prescribed either of those medications and discuss the necessity of them with each other.

You know what my opinion is on the perindopril given the blood pressure you have and the possibility that you suffered a TIA but ultimately it is a decision that you and your treating physician need to make together. Here are the details on the 2 interactions:

Classified as a SIGNIFICANT reaction

1. Either increases toxicity of the other by Other in terms of compromised renal function deterioration, particularly in elderly or dehydrated individuals.

2. Meloxicam decreases effects of perindopril by diminishing its antihypertensive effects.

I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with written feedback?

Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments or inquiries to me in the future at:

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I would be honored to answer you quickly and comprehensively.

Please keep me informed as to the outcome of your situation.
All the best.

The query has required a total of 21 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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Brief Answer:
Focal Low density change could be stroke....or not.....MRI better test

Detailed Answer:
Thank you for your updated information.

I would tend to agree with your concerns about taking blood pressure medications until:

1. It is more clear that you actually HAVE HYPERTENSION. In actuality, from a neurological point of view we tend to have much more tolerance for people over the age of 60 in terms of calling them HYPERTENSIVE to the point of having to use medications than internists or GP's think. We recognize and believe that the aging process itslef is likely to realize in rising BP's just by virtue of there being more calcific changes within the vasculature.

In other words, I don't draw such a BRIGHT LINE in folks over the age of 60 that come in with a bit of an elevation in either their systolic or diastolic pressures unless it is really OUT OF CONTROL. But let's say I do find someone who I think does in fact, have hypertension. I don't make the diagnosis on 1 pressure reading but rather on their coming back to the office on a few occasions and checking them and then, getting an average. Also, gotta make sure they haven't just had cigarettes, coffee, or anything that could cause their pressures to go up..stress, just after physical exertion, etc.

A 145/70 is not a pressure that I feel compelled to treat in a person of your age and in fact, is definitely one that I would prefer NOT to treat with pills until I had more information. Having said that I'd like to clarify that hypertension is one of the most common (if not the most common) risk factor for stroke outside of uncontrollable risk factors such as age. Therefore, it is important to treat hypertension for sure, however, in an 82 year old....I would want to be absolutely sure they have true blue hypertensive disease, I'd want to be sure there weren't any potentially treatable causes for the hypertension that could be treated without medication, and I'd want to know definitely that they did not have any blockages or obstructions in their carotid or other arteries that feed the brain BEFORE giving them blood pressure medications that could lower blood pressure and then, AS A RESULT of the treatment cause a stroke due to relative HYPOTENSION through a narrowed vascular opening. Make sense?

Bottom line is I would not treat someone in your position and given the information I have on you with antihypertensive medications until I had much more information.

As a final thought the CT scan is clearly NOT THE MOST sensitive type of imaging study to be able to firmly make diagnoses of cerebrovascular disease. If you could charm your physician into getting you an MRI as well as an MRA of the head and neck then, they would be following up with you in a much more diligent and reasonable fashion in order for a potential stroke patient to obtain as much information as possible before making decisions about whether there was a stroke or not and what if any intervention with medication or further workup should take place.

I hope this answer satisfactorily addresses your question. If so, may I ask your favor of a HIGH STAR RATING with written feedback?

Also, if there are no other questions or comments, may I ask you CLOSE THE QUERY on your end so this question can be transacted and archived for further reference by colleagues as necessary?

Please direct more comments or inquiries to me in the future at:

bit.ly/drdariushsaghafi

I would be honored to answer you quickly and comprehensively.

Please keep me informed as to the outcome of your situation.
All the best.

Cheers!

The query has required a total of 41 minutes of physician specific time to read, research, and compile a return envoy to the patient.

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