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What are the symptoms of a small stroke? What test should be done?

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Practicing since : 2003
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What are the symptoms of a small stroke, and how does one know if they have had one? Do they show on CT Scans? My friend had three seizures last week. She has never had one before. They were violent according to her family. Paramedics did take her to the ER. Now, she is confused, cannot process information or even follow the normal flow of a casual conversation. If these symptoms are not those of a stroke, why does is she having such a difficult time processing anything? These symptoms are getting worse by the day. She can't remember who is who nor shy she has called me, and gets the names of her family totally mixed up. I am very concerned about her. Could this possibly be the beginning stages of Alzeimers or Dimentia?
Posted Wed, 7 Nov 2012 in Stroke
Answered by Dr. Jonas Sundarakumar 5 hours later
Hello and welcome to Healthcare Magic. Thanks for your query.

I appreciate your concern for your friend's health condition. The most common indicators of a any stroke are neurological deficits. These defecits can be in the form of motor deficits (i.e. weakness or paralysis), sensory deficits (numbness or abnormal pain sensations), cranial nerve deficits (like speech disturbances, vision disturbances, etc. ), autonomic deficits (like bowel or bladder incontinence) or cognitive deficits (like disorientation, memory loss, inability to recognize faces, etc.)

Sometimes, there may not be obvious weakness or paralysis, but there may be subtle signs which indicate a stroke, like dizziness, slurred speech or difficulty in understanding, confusion, memory loss, severe headache, visual disturbances, difficulty in swallowing, etc.

In your friend's case, there has been a sudden onset of seizures, followed by cognitive deficits such as disorientation, difficulty in understanding / processing information and memory deficits. These symptoms are definitely indicative of a brain pathology or a neurological disorder. Considering her age and acute onset of symptoms, it is likely that the cause is a vascular problem (i.e. a stroke). Sometimes, multiple small emboli (i.e. blood clots) can cause global cognitive eficits like this. This is called a multi-infarct Dementia. But there could be other possibilities also, like a tumour or a meningo-encephalitis (brain infection) or a metabolic abnormality. You friend needs a detailed medical and neurological work up, which should definitely include a brain scan and few other lab tests.

It is unlikely to be Alzheimer's disease, because in Alzheimer's, the onset is gradual and progressive (not so acute as is your friend's case) and moreover, seizures are not characteristic.

Best wishes,

- Dr. Jonas Sundarakumar
Consultant Psychiatrist
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