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Slurred speech, suspected stroke, left arm numbness, headaches, on gapentain, dizapam, CT scan, blood test, brain MRI normal. Treatment ?

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Orthopaedic Surgeon
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Hi i am a 30 year old lady, who is 5 6 in height and weighs 12 1/2 stone, for the past 3 months nearly i have felt very unwell, it started as slurred speech and this went away then the week after at work i was took to hospital with a suspected stroke, as i had numbness in my left arm and face and bad headaches and slurness, they did a ct scan and mri on my brain which came back fine and said i had serious migrane and sent me home after 3 days, it got worse again and i was admitted again on the same ward, and they did another mri on my neck and back at the top and another mri on brain and blood tests and all came back fine, the slurred speech has gone but my left arm is still weak and my face and jaw are getting worse by the day, i was prescribed Gapentain and dizapam to help which does abit but the headaches are on and off constantly, my jaw and face are very uncomfortabel feeling and i have not been back work as yet as every day is a major struggle, am now off gapapentain as advised by my gp and on dizapam and ibuprofen, i have dentist next week even though i have no tooth ace etc my gp thinks it is TJD but i need an answer as this is not nromal as i am normally fit, also i have alot of saliva in my mouth and where they gave me an injection in my buttock in hospital since then it is very sore and constant numbness there and pain in my left leg
Posted Tue, 17 Apr 2012 in Brain and Spine
Answered by Dr. Aashish Raghu 25 minutes later

Thanks for the query.

You have provided with good information, but I need to know few more things to suggest you better.

1. Do you experience double vision or blurring of vision?

2. Is there any weakness of the face?

3. Do you have trouble sleeping at night, do you snore at night?

4. How is your blood pressure?

5. Are you/ have you been on any medication?

6. When you get the headaches, do you see flashes of light?

7. Provide me some more details of your past history of kidney Cyst.

There are various possibilities according to your history. Since you are overweight, possibility of Benign Intracranial Hypertension is possible which is common in obese women of age 20-50 years. Even MRI can come negative without any findings in such cases.

The other possibility is Familial hemiplegic migraine where weakness of the arms perhaps can be seen during headache, associated with flashes of light seen.

If your blood pressure is high and you have high blood lipids and Diabetes, there are more chances of Transient ischemic attack. It can cause symptoms of Stroke as well and also puts at risk for stroke in few months.

Face weakness is reported as well as recurring headaches, double vision. Rarely disturbance in walking will be seen. Certain drugs like Tetracyclines can cause this which is usually part of treatment for acne. Also obesity can cause sleep apnoea syndrome which can cause this disease as well.

You need to use the help of a caregiver or friend while walking around to avoid accidental falls if you feel dizzy.

You will need to reduce weight as this is very risky especially in setting of symptoms of stroke. Get your blood pressure, blood lipids, blood sugar checked to rule out Hypertension, Hyperlipidaemia and Diabetes respectively as they are risk factors for stroke and heart attack.

Excess saliva can be due to salivary gland disease or even if there is gastritis. Avoid spicy food, hot food.

Avoid high carbohydrate diet, fatty, fried, junk food. Eat plenty of fresh fruits and XXXXXXX leafy vegetables. Drink enough water. Exercise daily atleast by brisk walking for 40 minutes once you recover. Join a gym and do cardio workout for best results. Get 6-8 hours of sleep. If you have trouble sleeping and snoring occurs, sleep with head slightly elevated over 2-3 pillows.

You need to consult a Neurologist to evaluate you for the above mentioned possible causes of your condition and get a thorough checkup along with necessary investigations and appropriate treatment.

I hope I have answered your query. I will be available to answer your follow up queries.


Above answer was peer-reviewed by
Follow-up: Slurred speech, suspected stroke, left arm numbness, headaches, on gapentain, dizapam, CT scan, blood test, brain MRI normal. Treatment ? 49 minutes later
Hi Thanks for a good reply,

The answers to your questions are as follows:

I have no blurred vision or funny visions at all

My blood pressure has been monitored and has came back fine, i also had blood tests which they say rule out anything serious as they are fine

I don't snore at night but can't sleep well due to my mouth and face spasms and saliva in mouth very uncomfortable

I have been on Gapepentin, Dizapein, paracetomel for all of this

My cyst in Kidney was very bad it turned into blood infection which kept me in hospital for 3 weeks, i had it drained but there is still a cyst remaining on kidney, i sometimes get back pain at bottom but nothing serious otherwise

I was doing slimming world before this all happened and am aware my weight is slightly higher then what it should be, but my gp keeps saying i have had all tests that need to be done it is this TJC disorder thing, but i am going dentist but not entirley convinced as the slurred speech thing, which again they said major migrane, i feel i can not live a normal life as when i try to do things my face goes tight and head hurts and pains begin again, sleeping is the worst time, am i right in thinking you think there is something else up, the consultant at the hospital said he thinks it was a peripherial nervous system disease???

Any help what my next steps should be and do you think i should go back work, he suggested part time but i worry ill get ill again and be counted as more sick

Answered by Dr. Aashish Raghu 47 minutes later

Thanks for replying to my questions.

According to your history, it seems extremely less likely to be peripheral nerve disease because facial muscles involved accompanied by headache which suggest brain pathology. Migraine can be considered but in hemiplegic migraine, the arm weakness should disappear within 24 hours so it is highly unlikely as well as no family history mentioned.

Temperomandibular joint disease (TMJ disease) does not cause facial weakness, but rather pain and clicking sound, some times spasm of facial muscles on opening the mouth. It can be caused by arthritis of the jaw joint and also due to dental problems like malocclusion.

It is possible that it is a variant of migraine so I recommend you consult a Neurologist and get a thorough examination done. Drugs like Sumatriptan will be extremely helpful to prevent an acute attack. Drugs like Propranolol and Flunarizine are useful to prevent further attacks when taken for few days in a week. Avoid stress, do Yoga everyday to help in stress relief.

I hope, my recommendations are helpful for you.

Wishing you good health.

Above answer was peer-reviewed by
Follow-up: Slurred speech, suspected stroke, left arm numbness, headaches, on gapentain, dizapam, CT scan, blood test, brain MRI normal. Treatment ? 59 minutes later
Hi Thanks for good response

So you feel going to a dentist may help to see if any teeth problems but that would not be problem?

He felt my glands my GP and said felt fine but its pain just behind and in front of left ear worst and a tight feeling in neck when walking round like i cant lift it properly,i have started taking Gapapentasin again as i fgelt this did help me abit if honest.

The problem is my GP is saying all tests have come back fine so won't refer me but how can i carry on with this pain and worrying it is serious?

Also shoulde i try and go back work as again very hard to open mouth alot i.e talkiing and concentracting, can i find a local neurologist in my area myself on NHS?

Thanks Again
Answered by Dr. Aashish Raghu 9 minutes later

Thanks for writing again.

Tight feeling in the neck with painful glands could point to possible Fibromyalgia.

You need to find a Neurologist/Psychiatrist to help in making the differential diagnosis and after that management of the problem can be started.

Do not go back to work, if the problem disables you from carrying out chores. Yes, You may find a competent Neurologist based on NHS service.

Avoid stress. Get 6-8 hours of sleep. Add Yoga in your regime to help relieve stress as well.

I hope, I have answered your query.

Wishing you good health.

Above answer was peer-reviewed by
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