Question: My mother recently had a brief episode of blurry vision with mild headache that lasted 15 minutes. She is 70 but is in the shape of a 50 year old with no risk factors. She went to her general practitioner who ordered a CT. When she called us in the office she said that she had bad news. My mother had a stroke. She said "If I would have a list of all my patients of your age that I would think might have a stroke you would have been last on the list, you have no risk factors. You may just be one of the unlucky ones." She said most people who have a stroke will have another and may get dementia. She ordered an ultrasound of the neck and echo, but said in the absence of risk factors there is not much to do but take blood thinners and basically wait around for it to get worse (or at least that was my interpretation) . I am going to type the CT report below and hope that a neurologist can explain a little better. I am hoping that since she is not a specialist the gloom and doom prognosis was a little dramatic. We are in a bit of shock because my mom has not been sick a day in her life and literally has no risk factor other than stress. Please let me know if this report indicates a terrible outcome in the future.
FIndings: There are several scattered recent appearing small cortical infarcts in the occipital lobe bilaterally greater on the left. There is a moderate size recent appearing infarct in the left mid cerebellar hemisphere and a small recent appearing infarct in the left posterior mid cerebellar hemisphere. No hemmorage or evidence of vertebral or basilar occlusion.
There are moderate changes of ischemic microangiopathy in the central pons. There are moderate to multifocal changes of ischemic microangiopathy in the supratentorial white matter left greater than right. No regions of abnormal enhancement. Pituitary normal. Paranasal sinus and mastoids well aerated. Orbital contents normal.
My mom is a positive person but this confusion is really upsetting her. Please let me know if this is consider a large amount of damage with future repercussions. The doctor did not even classify if this was a XXXXXXX mild, severe or massive stoke. We have absolutely no family history so no experience with this. I should also add that after the blurry vision and headach subsided in about 15 minutes she was fine and had to be talk into going to the doctor 2 days later, she feels totally normal now. Thanks!

Is this over the head of the general practitioner and better handled by a neurologist? The doctor seemed so negative!
Should she be checked for atrial fibrillation?
And most importantly in her mind, if she follows the orders of the doctor will she still have a low risk of dementia based on the damage already done? Her mom is 93 and going strong...so she is very concerning to think she is at high risk of dementia. It's just not something we ever thought we would have to worry to much about until now. Thanks so much!

Her cholesterol is always borderline but not high. She just had bloodwork done to check again.
I have two more questions if you don't mind:
1. On the findings there was the section that talked about the infarcts and then another section that stated "moderate changes of ischemic microangiopathy in the central pons" and "moderate to multifocal changes of ischemic microangiopathy in the supratentorial white matter left great than right". Is the later section in regard to damage caused by the stroke...or is it incidental findings of the CT scan. Either way, what does it mean exactly and is it a dementia concern? I am not sure if we are talking about two different problems here or if the report is all related to the stroke. (I am wondering if there is something separate to do to stop the narrowing.)
2. What if she has every risk factor assessed and they all check out OK. If there are no risk factors to address and it is age related, is it impossible to stop the progression or will the thinners and meds help?
You have helped tremendously and I appreciate your time. This is very all very difficult (and scary) for someone with no experience with stroke to grasp.

She had an ultrasound of the neck and it was good. Echo has not come back yet. That is all the tests other than the MRI. She got her bloodwork this evening and her cholesterol is 225. She is afraid of the lipid lowering drugs because they made my dad very ill. Would niacin work to lower the cholesterol, or in this case does she need to try the drugs?
As far as other risk factors she does not have high blood pressure, diabetes, she is not overweight, nor does she drink or smoke. She is physically active. Is a reading of 225 for cholesterol a big enough risk factor in itself? Thanks again!

Yes, she had it all but I don't have the report at the moment. I do know the upper range of normal was 200, but hers was 225. So, I guess she needs the drugs.
And one last thing just because I am curious...Is it fairly normal to see a moderate level of ishemic change on a CT for a 70 year old, or is the amount of change on her report much more advanced than would be expect for someone her age.
Thanks, the information has been very helpful!

Thank you I will get her report this afternoon. Both of her parents lived into the 90's. Is it possible to live to be that old with this level of ischemia and not get dementia (if it is controlled). I know I am dwelling on the dementia but that idea is really bothering her.