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Neurologist How would you differentiate (actually, I mean…

Neurologist How would you differentiate (actually...
Neurologist
How would you differentiate (actually, I mean diagnose) between a TIA and a Cortical Spreading Depression hours after occurrence? I know the speed of onset matters, but what about physical changes? Is there damage that differs with each? I have heard that many people are diagnosed incorrectly with a TIA when it might have been a CSD. I have also heard that people with either TIA or CSD/Aura may or may not have lesions or things that show up on imaging. I know someone, like me (I've had SS for 30 years), that has Scintillating Scotomas without headache who was diagnosed with a TIA, but she failed to tell them she has a history of SS caused by CSD. can you sort this out for me? She smokes, I don't.
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Answered in 11 hours by:
6/26/2010
Jack Scariano Jr
Jack Scariano Jr, Neurologist (MD)
Category: Neurology
Satisfied Customers: 1,057
Experience: Board Certified Neurology 1982 30 years experince. Also expert in Pain Medicine
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The differentiation between CSD and TIA can be diagnosed even hours later by diffusion weighed mri scan. This would show changes up to 6-8 hrs after a TIA but would be normal after CSD.

CSD can be seen with seizures, migraines and other transient neurological diorders.

They are best seen on a PET scan, if you have anepisode while you are being scanned

They can be migraine prodrome and you do not always have a headache with migraine prodrome.

The best treatment for TIA is to reduce risk factos and take a anti-platelet drug such as

plavix.

The newer anticonvulsants in low dosages are often prophylactic to prevent CSD.

Hope this helps

DrS

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Customer reply replied 8 years ago

I know that the diffusion weighted mri scan "can" help diagnose a TIA, but I heard that emergency rooms diagnose TIAs even when nothing shows up, particularly when other factors are present. In her case, she was previously diagnosed with lupus and is/was a smoker. She reported weakness in the arms and legs and balance problems. She did not report her history of aura without headache. Note: I can tell you that in my case, these type of symptoms from the prodrome (as well as numbness on the face) are present and have been present for over 30 years. Is it possible she was misdiagnosed if nothing showed up on the mri?

So... a female patient (46 years old) with no history of migraine, has lupus, and is a 30 year smoker, reports/presents the symptoms above and shows nothing on the weighted mri to suggest TIA or stroke, what would you diagnose?

Lastly, the Dr gave me Treximet for Scintillating Scotoma last year, but the drug side efects were so scary I never took it. I am interested in any drugs tht help, but don't have side effects like Treximet. I heard that these auras are caused by CSDs and can cause lesions (I presume that is what shows up on a weighted MRI scan) and even lead to TAs or stroke... that here is an association and that certain drugs could help lessen the likelihood of damage to the brain. Am I on track here?

Diffusion weighted mri show segmental blockage or larger arterioles of branch arteries. You can think of it like a tree. The trunk bring one carotid arteries which then branches out just like a tree. If one of the main branches or even smaller branches dies, you can see it, But when the twigs and leaves fall, it is hard to see the untill the damage is widespread and the tree has less and less leaves. Vasvular disease of the brain is like this and the smaller the strokes, the harder they are to see untill the effects

are seen as larger segmental strokes or atrophy secondary the multiple ministrokes.This analogy is to explain why diffusion mri is sometimes negative with ministokes.

I know of no other tests that are available in an ER that are more diagnostic then diffusion weight MR. Sometimes on a experimental study patients undergo PET

Scan Positron emission Tomography. This shows brain metabolic changes. It takes two to three hours, the patient must lay perfectly still. It has been shown to be less accurate then diffusion weight mri.

All studies in Neurology,cardiology, surgery, etc have shown the the most accurate diagnosis of any illness is made by trained MD..The tests aare the pieces that help us make a diagnosis and formulate treatment.

A 46 y/o female with lupus and smokes has very high risk factors for vascular disease anywhere in the body. Oher factors may also be present such as meds, hormones, family history, lipids etc. With my training and having seen hundreds of patients with these symptoms for at least 10 years before the MRI was available, you were having a ministroke( leaf falling off analogy).

Medicine is about treating patients and improving ot maintaining their quality of life. The abnormality on the objective test is helpful, but does not make the diagnosis without someone to put all of the data together.

I would not take treximet or any tryptain due to your other risk factor. I would see a cardiologist for a full vascular evaluation and to evaluate your risk facors for vascular disease.

Take asperin and of course give up SMOKING...... Smoking is the worst thing you can possibly do for your health with your history and lupus diagnosis.

Hope this helps,

Dr S

Jack Scariano Jr
Jack Scariano Jr, Neurologist (MD)
Category: Neurology
Satisfied Customers: 1,057
Experience: Board Certified Neurology 1982 30 years experince. Also expert in Pain Medicine
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Customer reply replied 8 years ago

I accept your answer, but it isn't me with lupus and I never smoked, it is the ex-wife. I have been taking the 81mg aspirin for 22 years, my cholesterol is 150 with HDL at 60. CRP is fine. I am 62 and am athletic. All my bloodwork is excellent and my BP is 108 over 68.. HR is 62. I exercise alot (run and lift weights) and eat really well. I take no medications. The scintillating scotomas (SS) are a little weird, but when I found out what they are, I am ok with it. BTW, I had the thallium stress test and all was . The aura is triggered by chocolate and/or sweets. I never eat them, but on the rare occasions when I have, I get the aura. My blood sugar is normal, but I was once diagnosd with reactive low blood sugar. That was 30 years ago when I had my first SS.

It is my understanding that TIAs leave no damage or lasting symptoms (more than a day) and for that reason: 1) They are hard to distinguish from aura/prodrome/SS, and 2) TIAs are not really "strokes" that leave permanent damage and the term "mini-stroke" is a misnomer.

TIAs resolve in minutes or hours. Scintillating Scotoma lasts 20-45 minutes usually. Very similar, except for the onset. But my research (on the web) shows people getting a diagnosis of TIA that later is determined to be an SS/aura/migraine without headache.

I was just trying to find out whether you thought TIAs are a simple diagnosis, like a stroke. I think the answer is "no", based on your response AND particularly since patient medical history is a huge part of the TIA diagnosis, especially when nothing shows on the weighted MRI.

Thanks.

Thanks.

I hope that I answered your question. The diagnosis is often confusing and response to treximet type drugs oftens helps determine the diagnosis. However they do have many potential side effects.

.

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