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What are the warning signs of a TIA?

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Dr. Ashok Kumar

Psychiatrist

Practicing since :2000

Answered : 2713 Questions

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Posted on Tue, 12 Jun 2018 in Mental Health
Question: How can I know if I had a TIA or am suffering from a conversion reaction? Two doctors disagree. One says TIA and the other says conversion reaction.



Tuesday, I went to the hospital with vertigo, drowsiness, loss of balance, inability to stand or walk, and right leg paralysis. The CAT scan was normal, so the neurologist diagnosed me with conversion reaction and discharged me.

My hematologist disagrees with that diagnosis. Two months ago he diagnosed me with hypercoagulation from a positive TEG test and high fibrinogen, which prove that I have frequent blood clots. He is treating it with 80 mg Lovenox shots and 10 mg Warfarin daily. The frequent strokes and TIAs I have been having for the past three years have stopped when I was put on Lovenox, and returned when it was discontinued. (I was not on Lovenox when I had the symptoms on Tuesday and my INR was 1.1 which means my hypercoagulation was not being effectively treated.) He says that is because my blood protein is all screwed up, producing clots that get stuck in my small brain vessels, reducing the oxygen and causing strokes/mini-strokes. The neurologist said the TEG test is antiquated and that I am not hypercoagulable and shouldn't be taking treatment for it because I am not having strokes or TIAs, just mental illness.

So, who should I believe? Should I see a psychiatrist, take medicine for depression and anxiety, stop taking the Lovenox and Warfarin for blood clots, and refuse to seek medical treatment when I have stroke symptoms, because it is all just "in my head"? Or, should I stay on the medicine to thin my blood and prevent clots, and seek medical attention if I feel stroke symptoms, because it might be life-threatening? I thought conversion reaction could only be diagnosed when all physical causes have been ruled out, but I have confirmed physical problems (hypercoagulation according to blood tests, many stroke lesions shown on my MRI, moderate to severe stenosis of several blood vessels in my brain.).

Yesterday, I took an online anxiety test and scored normal. I haven't taken an online depression test, but it would probably be normal, too. So how is it possible for me to have conversion reaction, when I am neither depressed nor anxious? Is it possible that I am so repressed that I am not even aware of them? Here are the anxiety test results, which I think provide a true description of me.

"You seem like a well-adjusted and well-rounded person. You have little signs of generalized anxiety, and it seems like you don’t usually dwell in negative thought patterns. You have a clear notion that just worrying about problems is futile, and you prefer focusing on finding solutions. Your healthy attitude toward life is likely to provide you with some enjoyable perks, such as having a stable mood, an upbeat personality, and no trouble sleeping. You don’t usually feel irritable, and you can easily focus your mind when a new task requires your attention. Life is a highway, and you have certainly learned how to effectively use your inner cruise control.

Even though you may have occasional stress, it’s unlikely to ever translate into serious physical symptoms. You may sometimes feel fatigued and tense and even experience minor digestive problems, but those are very normal reactions to having a modern and fast-paced lifestyle. All in all, you have much to be thankful for; anxiety is a terrible plague disrupting the life of millions of people worldwide, but you are part of the privileged group of people whose anxiousness doesn’t really diminish their physiological well-being.

According to your test results, you don’t seem to suffer too much (or at all) from mood instability. You are probably a very calm and relaxed person, and you have a healthy way of dealing with stress and tension. You know that patience is a virtue, and you strive to cultivate it within yourself; you are capable of managing your emotions just fine, and your mood is usually stable. Granted, everyone has occasional bad days, and you are no exception; however, you seem to be the kind of person who knows how to take the bad things in life as elegantly as the good things.

It seems that you are generally a happy person and you are satisfied with your life. You have learned to accept that some things are beyond your control, and you normally see things from a positive perspective. You feel right walking in your own shoes, and you don’t spend too much time dwelling in futile existentialisms. As far as you’re concerned, the point of life is just living and having the most fun while you can. You have a sense of meaning and purpose, and your flashes of anxiety are few and far between. You have good reasons to be proud since you’re more stable and happy than most people!

Most people seem to have a masochist tendency to overthink and analyze—not you. According to your results, you seem well aware of the fact that math problems can’t be solved by chewing bubble gum. In other words, when you have a problem, you either find a way to deal with it or move on; dwelling in possibilities and ruminations is not something you usually lend yourself to, and that’s actually a blessing! Free from self-inflicted nagging, your mind is able to remain clear and focused on command, and you always know what to do in the face of adversity."
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Answered by Dr. Ashok Kumar 46 minutes later
Brief Answer:
Consultation

Detailed Answer:
Hello,
Thanks for using Health care magic.

I read your with keen interest and understand your concerns.

The available description do not suggest anything near to conversion reaction including age of the onset, nature of problem, MRI scan report, hypercoagability, symptoms experienced, remission with medications among others. The only point in favor of conversation reaction is normal scan report but the small strokes and TIAs are rarely idenified by CAT scan.

In my opinion there is little doubt if any about the TIA diagnosis and almost nil evidence in favor of conversation reaction.

I hope this helps you.
Feel free to write back to me if you have more questions.
Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Ashok Kumar 17 minutes later
Thank you for your response, Dr. XXXXXXX You have greatly eased my mind. You have explained why this is most likely not conversion reaction and probably TIA. I will put this question out of my mind, and proceed with the medical treatment from my hematologist with confidence.

Regards,

XXXX
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Answered by Dr. Ashok Kumar 9 hours later
Brief Answer:
Follow up

Detailed Answer:
Dear XXXXXXX
Thanks for follow up and positive feedback.

I am glad to know that my answer was helpful for you.
If you have any further query, I would be glad to help you.

In future if you wish to contact me directly, you can use the below-mentioned link:
http://doctor.healthcaremagic.com/doctors/dr-ashok-kumar/67386

Thanks and regards.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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