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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

Exp 50 years

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Since 1/15/2019, I have had daily TIAs. My symptoms include:

Answered by
Dr.
Dr. Kaushal Bhavsar

Pulmonologist

Practicing since :2008

Answered : 14575 Questions

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Posted on Sat, 9 Mar 2019 in Sleep Disorders
Question: Since 1/15/2019, I have had daily TIAs. My symptoms include:

dizziness (vertigo) or lightheadedness
sudden, severe weakness throughout my body
slurred (or garbled) speech
difficulty walking
sleepiness

Sometimes I have left or right leg paralysis, inability to write other than scribbles, or right facial droop.

It starts with my blood pressure is normal 116/55 but my heart rate is 30-45 points higher than normal at 91-114. Then my bp rises to 156-195. Sometimes I pass out for up to five hours and can’t be aroused at all. It lasts for 2-6 hours then resolves completely. I looked up the symptoms and it fits perfectly with a condition called vertebrobasilar insufficiency. Do you think that is possible? If so, what should I do about it?
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Follow up: Dr. Kaushal Bhavsar 0 minute later
Since 1/15/2019, I have had daily TIAs. My symptoms include:

dizziness (vertigo) or lightheadedness
sudden, severe weakness throughout my body
slurred (or garbled) speech
difficulty walking
sleepiness

Sometimes I have left or right leg paralysis, inability to write other than scribbles, or right facial droop.

It starts with my blood pressure is normal 116/55 but my heart rate is 30-45 points higher than normal at 91-114. Then my bp rises to 156-195. Sometimes I pass out for up to five hours and can’t be aroused at all. It lasts for 2-6 hours then resolves completely. I looked up the symptoms and it fits perfectly with a condition called vertebrobasilar insufficiency. Do you think that is possible? If so, what should I do about it?
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Follow up: Dr. Kaushal Bhavsar 33 minutes later
I forgot to mention that I am shaking all over, teeth chattering, regurgitate in my throat, and lose my balance and almost fall, especially on stairs.
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Follow up: Dr. Kaushal Bhavsar 0 minute later
I forgot to mention that I am shaking all over, teeth chattering, regurgitate in my throat, and lose my balance and almost fall, especially on stairs.
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Follow up: Dr. Kaushal Bhavsar 6 minutes later
And sometimes I become incontinent with my bowels. I’m having an episode right now and my bp is 182/99 with heart rate 109.
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Follow up: Dr. Kaushal Bhavsar 0 minute later
And sometimes I become incontinent with my bowels. I’m having an episode right now and my bp is 182/99 with heart rate 109.
doctor
Answered by Dr. Kaushal Bhavsar 1 hour later
Brief Answer:
Yes, your symptoms are suggestive of vertebrobasilar insufficiency.

Detailed Answer:
Thanks for your question on Ask a doctor forum.
I can understand your concern.
I have gone through the detailed history you have given.
Yes, your symptoms are suggestive of vertebrobasilar insufficiency.
In my opinion, you should immediately rush to emergency room and get done clinical examination and MRI of brain with angiography if brain vessels.
Try to meet neurologist (neurophysician) earliest.
Don't wait at home, rush to emergency as this can be life threatening.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Kaushal Bhavsar 0 minute later
Brief Answer:
Yes, your symptoms are suggestive of vertebrobasilar insufficiency.

Detailed Answer:
Thanks for your question on Ask a doctor forum.
I can understand your concern.
I have gone through the detailed history you have given.
Yes, your symptoms are suggestive of vertebrobasilar insufficiency.
In my opinion, you should immediately rush to emergency room and get done clinical examination and MRI of brain with angiography if brain vessels.
Try to meet neurologist (neurophysician) earliest.
Don't wait at home, rush to emergency as this can be life threatening.
Hope I have solved your query. I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Kaushal Bhavsar 12 hours later
Thanks for your answer. Yesterday eight after I wrote this question, I called my primary doctor and relayed my symptoms and blood pressure. He said to take .2 mg of clonidine. I did, and became drowsy. I fell asleep for 13 hours. When I woke up my symptoms were gone and my bp is 139/79 heart rate 88. Since I have these episodes every day, should I wait for the next one and then go to the ER? Why would it happen every day, and how can I get it to stop?
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Follow up: Dr. Kaushal Bhavsar 0 minute later
Thanks for your answer. Yesterday eight after I wrote this question, I called my primary doctor and relayed my symptoms and blood pressure. He said to take .2 mg of clonidine. I did, and became drowsy. I fell asleep for 13 hours. When I woke up my symptoms were gone and my bp is 139/79 heart rate 88. Since I have these episodes every day, should I wait for the next one and then go to the ER? Why would it happen every day, and how can I get it to stop?
doctor
Answered by Dr. Kaushal Bhavsar 8 minutes later
Brief Answer:
I think you should go to ER.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
In my opinion, you should go to ER and get detailed neurological examination and MRI of brain done at the earliest.

Because all your symptoms are more suggestive of brain pathology.
And if this is neglected, it can be life threatening.
So better to first rule out brain pathology.
If MRI is normal then no need to worry.

Hope I have solved your query.

I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
doctor
Answered by Dr. Kaushal Bhavsar 0 minute later
Brief Answer:
I think you should go to ER.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
In my opinion, you should go to ER and get detailed neurological examination and MRI of brain done at the earliest.

Because all your symptoms are more suggestive of brain pathology.
And if this is neglected, it can be life threatening.
So better to first rule out brain pathology.
If MRI is normal then no need to worry.

Hope I have solved your query.

I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Kaushal Bhavsar 2 hours later
I had an MRI on 12/20/18 when I went to the ER with impaired speech. I was diagnosed with a TIA. My MRI said "MRI brain: No acute infarct. Stable old left gangliocapsular infact involving the caudate head. Stable pattern of scatttered and confluent foci of T2 prolongation involving the periventricular, deep and subcortial white matter of bilateral cerebral hemispheres and the pons, nonspecific but most likely reflecting chronic small vessel ischemia moderately advanced for age. Alternative etiologic considerations include chronic demyelinating disease such as multiple schlerosis. MRI brain perfusion scan: No focal perfusion abnormality identified to suggest acute infarct or ischemia." Is any of that concerning, and if so, what should I do about it?
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Follow up: Dr. Kaushal Bhavsar 0 minute later
I had an MRI on 12/20/18 when I went to the ER with impaired speech. I was diagnosed with a TIA. My MRI said "MRI brain: No acute infarct. Stable old left gangliocapsular infact involving the caudate head. Stable pattern of scatttered and confluent foci of T2 prolongation involving the periventricular, deep and subcortial white matter of bilateral cerebral hemispheres and the pons, nonspecific but most likely reflecting chronic small vessel ischemia moderately advanced for age. Alternative etiologic considerations include chronic demyelinating disease such as multiple schlerosis. MRI brain perfusion scan: No focal perfusion abnormality identified to suggest acute infarct or ischemia." Is any of that concerning, and if so, what should I do about it?
doctor
Answered by Dr. Kaushal Bhavsar 5 minutes later
Brief Answer:
Start anti platelet.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
I have gone through the MRI report you have mentioned.
In my opinion, you should start anti platelet and blood thinner drug.

I will suggest to see a neurologist and start on these medicines, if these are not started already.

I will be happy to help you further. Wish you good health.

Thanks
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Kaushal Bhavsar 0 minute later
Brief Answer:
Start anti platelet.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
I have gone through the MRI report you have mentioned.
In my opinion, you should start anti platelet and blood thinner drug.

I will suggest to see a neurologist and start on these medicines, if these are not started already.

I will be happy to help you further. Wish you good health.

Thanks
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Kaushal Bhavsar 27 minutes later
From my research, cerebral small vessel disease is a disease of the elderly. It first appeared on an MRI when I was 63, when I had a series of lacunar infarcts. It had obviously been there for some time. Since that is too young to be considered elderly, do you think it is not age-related, but something else? From my research, I found the following diagnoses: "The following diagnoses were established: widened perivascular spaces in 11 cases, foci most probably associated with brain aging -21, with migraine -15, ischaemic changes -52, vasculitis -12, hypoxic-ischaemic changes -8, haemorrhagic foci -11, inflammatory changes -20, multiple sclerosis -50, central pontine and extrapontine myelinolysis -7, metastases -7, changes caused by radio-and chemotherapy - 8, lesions associated with neurometabolic diseases - 10, CNS degenerative diseases - 13, eclampsia - 1."

How can I know if I have any of these diseases?
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Follow up: Dr. Kaushal Bhavsar 0 minute later
From my research, cerebral small vessel disease is a disease of the elderly. It first appeared on an MRI when I was 63, when I had a series of lacunar infarcts. It had obviously been there for some time. Since that is too young to be considered elderly, do you think it is not age-related, but something else? From my research, I found the following diagnoses: "The following diagnoses were established: widened perivascular spaces in 11 cases, foci most probably associated with brain aging -21, with migraine -15, ischaemic changes -52, vasculitis -12, hypoxic-ischaemic changes -8, haemorrhagic foci -11, inflammatory changes -20, multiple sclerosis -50, central pontine and extrapontine myelinolysis -7, metastases -7, changes caused by radio-and chemotherapy - 8, lesions associated with neurometabolic diseases - 10, CNS degenerative diseases - 13, eclampsia - 1."

How can I know if I have any of these diseases?
doctor
Answered by Dr. Kaushal Bhavsar 23 minutes later
Brief Answer:
Your diagnosis should be ischemic changes.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
In my opinion, your diagnosis should be ischemic changes and hence anti platelet and blood thinner should be started.
I am more interested in your neurologist view on this MRI report.
Didn't he started anti platelet drug?
Do you have any skin lesions or joint pain?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
doctor
Answered by Dr. Kaushal Bhavsar 0 minute later
Brief Answer:
Your diagnosis should be ischemic changes.

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
In my opinion, your diagnosis should be ischemic changes and hence anti platelet and blood thinner should be started.
I am more interested in your neurologist view on this MRI report.
Didn't he started anti platelet drug?
Do you have any skin lesions or joint pain?
Please reply me answers of above asked questions, so that I can guide you better. I will be happy to help you further. Wish you good health. Thanks.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Kaushal Bhavsar 5 hours later
I don’t have any skin lesions or joint pain. I was on Clopidigrel platelet drug for several years, but I continued to have strokes and TIAs. My neurologist took me off and put me on Xarelto blood thinner. I took it for a month and continued to have TIAs. I voluntarily stopped it because I thought it was too dangerous to take, that it might cause micro bleeds in my small vessels. I read it was not recommended if you have small vessel disease. My neurologist wants me to go back on it.
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Follow up: Dr. Kaushal Bhavsar 0 minute later
I don’t have any skin lesions or joint pain. I was on Clopidigrel platelet drug for several years, but I continued to have strokes and TIAs. My neurologist took me off and put me on Xarelto blood thinner. I took it for a month and continued to have TIAs. I voluntarily stopped it because I thought it was too dangerous to take, that it might cause micro bleeds in my small vessels. I read it was not recommended if you have small vessel disease. My neurologist wants me to go back on it.
doctor
Answered by Dr. Kaushal Bhavsar 2 hours later
Brief Answer:
Yes, you should definitely restart it.

Detailed Answer:
Thanks.
I can understand your concern.

Yes, you should definitely restart it.
No need to worry for bleeding from small vessels.
And it is strongly indicated in your case.
So restart Xeralto.

I will be happy to help you further. Wish you good health.
Thanks.


Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
doctor
Answered by Dr. Kaushal Bhavsar 0 minute later
Brief Answer:
Yes, you should definitely restart it.

Detailed Answer:
Thanks.
I can understand your concern.

Yes, you should definitely restart it.
No need to worry for bleeding from small vessels.
And it is strongly indicated in your case.
So restart Xeralto.

I will be happy to help you further. Wish you good health.
Thanks.


Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Kaushal Bhavsar 1 hour later
I will take Xarelto, and also Cilostazol to reduce endothelial dysfunction in my white matter. I read in an article in Science Magazine that the following drugs are reported to reduce endothelial dysfunction: simvastatin, a cholesterol-lowering drug; perindopril, an angiotensin-converting enzyme inhibitor (ACEI); or cilostazol, a phosphodiesterase inhibitor. The article said that SVD brains have dysfunctional ECs.

http://stm.sciencemag.org/content/10/448/eaam9507.full

Science Translational Medicine 04 Jul 2018:
Vol. 10, Issue 448, eaam9507
DOI: 10.1126/scitranslmed.aam9507
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Follow up: Dr. Kaushal Bhavsar 0 minute later
I will take Xarelto, and also Cilostazol to reduce endothelial dysfunction in my white matter. I read in an article in Science Magazine that the following drugs are reported to reduce endothelial dysfunction: simvastatin, a cholesterol-lowering drug; perindopril, an angiotensin-converting enzyme inhibitor (ACEI); or cilostazol, a phosphodiesterase inhibitor. The article said that SVD brains have dysfunctional ECs.

http://stm.sciencemag.org/content/10/448/eaam9507.full

Science Translational Medicine 04 Jul 2018:
Vol. 10, Issue 448, eaam9507
DOI: 10.1126/scitranslmed.aam9507
doctor
Answered by Dr. Kaushal Bhavsar 5 hours later
Brief Answer:
Who prescribed you Cilostazole?

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
Yes, you should definitely start Xeralto.
No question about this.
And who prescribed you Cilostazol?
Are you self medicating?
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
doctor
Answered by Dr. Kaushal Bhavsar 0 minute later
Brief Answer:
Who prescribed you Cilostazole?

Detailed Answer:
Thanks for your follow up question on Ask a doctor forum.
I can understand your concern.
Yes, you should definitely start Xeralto.
No question about this.
And who prescribed you Cilostazol?
Are you self medicating?
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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