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What causes transient ischemic attack symptoms?

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Posted on Mon, 23 Jun 2014
Question: I am having daily episodes of TIA like symptoms. I awoke the other day and could not talk for about 30 seconds. I had no control over my right arm like it fell asleep. Bot legs were numb and weak as was my arms. I had no balance. I had a severe headache in te back of my head in the neck area on the right side. Loud ringing in the ears and a feeling a disconnection. Almost as if I'd smokes marijuana. I had a momentary feeling of not knowing here I was. And of course, I was in a panic!!



These attacks happen almost every time I wake up. It doesn't matter if I sleep 3 hours or 20 minutes. I have COPD and have high co2 level. LIke 67-72. And sometimes 80's. I also have been realizing that I de-sat at night and have woken up with a pulse ox reading of 71 to the lower 80's. I have visual symptoms of a migraine aura and am very sensitive to light and sound. And I am in a constant brain fog and having balance problems.



I have had a workup that has included a brain MRI, Caroted scan, CT Scan, Spinal tap, Echocardiogram. All unremarkable except that one carotid scan showed 50 blaockage and the other scan was normal at another facility. So, there is a contradiction...



Was just discharged from XXXXXXX Clinic yesterday in this condition because they said insurance would no allow me to stay and find out what is wrong. They simply ruled out an acute stroke but refused to help me.... They want me to return as an outpatient which I can not do. I am in a wheelchair on oxygen, do not drive and live 2 hours away from them. I was sent there by ambulance from a local ER.

What are your thoughts? I need HELP! I am non-functional right now and scare I might be in danger. No one will help me. They keep saying everything is chronic and want me to wait & wait.........
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Answered by Dr. Vivek Chail (7 hours later)
Brief Answer:
It might be related to any sleep related apnea

Detailed Answer:
Hi XXXX
Thanks for writing in to us.

I have read your query in detail. The symptoms experienced by you might relate to wake up stroke/ TIA like episodes which may be due to prolonged breath holds
of more than 20 seconds during obstructive sleep apnea and an abnormality in the heart which is medically known as right to left shunt. This can be confirmed only by doing a complete cardiac evaluation including an echocardiography. However you say that an echocardiogram has been done and it is normal.

Even without cardiac problems, there are patients who experience wake up stroke and TIAs due to obstructive sleep apneas. Research has shown that that changes in cerebral blood flow and perfusion are so significant and rapid in patients with sleep apnea that cerebral autoregulation is insufficient to protect the brain from changes in arterial blood pressure. They suggest that along with apnea/hypopnea–induced hypoxemia, these changes in cerebral blood flow parameters predispose patients with sleep apnea to nocturnal cerebral ischemia.

It is also seen that successful treatment of patients with OSAS has been shown to reduce morbidity and mortality due to cardiovascular causes.

I suggest you discuss any sleep related problems in detail and get it investigated.

The carotid artery Doppler needs to be verified as a blockage of 50% is mild obstruction and needs medical treatment. I suggest you please send me the reports if possible so that I can understand it better.

Hope I have been able to answer your query.
Do write back if you have any doubts.

Regards,
Dr.Vivek
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Vivek Chail

Radiologist

Practicing since :2002

Answered : 6865 Questions

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What causes transient ischemic attack symptoms?

Brief Answer: It might be related to any sleep related apnea Detailed Answer: Hi XXXX Thanks for writing in to us. I have read your query in detail. The symptoms experienced by you might relate to wake up stroke/ TIA like episodes which may be due to prolonged breath holds of more than 20 seconds during obstructive sleep apnea and an abnormality in the heart which is medically known as right to left shunt. This can be confirmed only by doing a complete cardiac evaluation including an echocardiography. However you say that an echocardiogram has been done and it is normal. Even without cardiac problems, there are patients who experience wake up stroke and TIAs due to obstructive sleep apneas. Research has shown that that changes in cerebral blood flow and perfusion are so significant and rapid in patients with sleep apnea that cerebral autoregulation is insufficient to protect the brain from changes in arterial blood pressure. They suggest that along with apnea/hypopnea–induced hypoxemia, these changes in cerebral blood flow parameters predispose patients with sleep apnea to nocturnal cerebral ischemia. It is also seen that successful treatment of patients with OSAS has been shown to reduce morbidity and mortality due to cardiovascular causes. I suggest you discuss any sleep related problems in detail and get it investigated. The carotid artery Doppler needs to be verified as a blockage of 50% is mild obstruction and needs medical treatment. I suggest you please send me the reports if possible so that I can understand it better. Hope I have been able to answer your query. Do write back if you have any doubts. Regards, Dr.Vivek