Difficulty speaking followed by headache

[kittynurse]

I'm hoping someone can help me figure out if I need to be alarmed and rush my mum to the ER.  Today when I was picking up my boys from her place (my parents had babysat the boys for a couple of hours today) my mum mentioned a "funny incident" that happened to her yesterday.

She said that she was in their kitchen and wanted to tell my dad that he should let the cat in (the cat goes out on a leash in their backyard).  She said that she couldn't get the words out.  She knew what she wanted to say but it just wouldn't come out.  Following that she said she had a dull headache.  She said she sat down for about 10 minutes and then it went away.  She said that she was completely fine before and she seemed fine to me today.  I asked her if she had any weakness at the time she couldn't speak and she said no.

Pertinent info:  She is in her late 70s but I would describe her as a "young elderly" if you know what I mean.  She has Type 2 diabetes that is controlled with diet and high blood pressure that is controlled with medication.  I believe she is also on a cholesterol medication.  My parents just returned from a month long cruise to the Pacific side of Central and South America (returning well before the events in Japan).

She didn't seem overly concerned about the incident and does conveniently have a doctor's appointment on Thursday and says she will mention it.  I didn't want to alarm her by asking too many questions because she seems totally fine at the moment but I have to admit, I was alarmed by it.

Does anyone have any ideas about possibilities and whether I should take action sooner?  I do have a couple of ideas in my head but want to get some opinions.  My mum is prone to anxiety so I worry that getting her worked up would be more harmful than helpful.

TIA

Martha

[mamaof5boys]

I don't remember much because I was only 9 years old, but my grandmother passed away from a stroke after intense, persistent headaches.  When I read your post it made me very concerned.  The lack of coordinated speech, coupled with a headache would make me get to a doctor ASAP.  I wouldn't wait.  Prayers for you and your mom!

[MisaGoat]

I would take her in ASAP.

[greenmulberry]

Take her to the ER, these are signs of a stroke!

[limette]

Definitely go in. Mini strokes often happen before the big one.

[tessie]

I agree that it would be advisable to seek medical advice ASAP. It could be a stroke or a TIA.

Hope all is well.:)

[starling&diesel]

Absolutely take her in immediately.  Does she have a blood pressure machine at home?  If so, get her to take her BP.  If it is at all elevated, then rush all that much faster, or call an ambulance.  At the very least, it sounds like a TIA (or "mini stroke") which is a Transient Ischemic Attack.  A TIA looks and acts like a stroke, but with few or no lasting affects.  But the cause is often the same for a stroke.  Many hospitals have a "hot stroke" protocol, because time is of the essence when it comes to strokes.

I'm a paramedic, and would definitely take her in.  No doubt.  Get her seen.  Get her vitals checked.  Get bloodwork done.  Go! 

[kittynurse]

Crap, that's what I thought you guys would say.  Man, being an only child SUCKS!  Thank you for your input especially starling&diesel.  I'll call her and ask her to check her blood pressure and go from there.

Martha

[kittynurse]

Ok, so I managed to convince her to check her blood pressure and it was within normal range.  I suggested calling the nurse's line at the doctor's office to get their opinion because I know if I drop the "you need to go to the hospital" bomb she will dig her heels in and refuse.  She says she will call in the morning.  GAH!!!  Will eat dinner, regroup and try again to convince her.  May have DH call because she adores him and will do anything he says despite the fact that I'm the one with health care training (I'm a vet tech but a lot is applicable).  My only other option after that is to kidnap her and drag her to the hospital.

Martha

[kittynurse]

So, I got DH to call and tell her that I was worried.  He put me on the line and I told her that I would feel much better if she would just call tonight.  So she did and is now waiting for a call back.  I'm anticipating an ER visit tonight because the health line virtually always sends you if it is anything remotely serious.

Will update when I have more information.

Thanks again for your help.

Martha

[midnightwriter]

Hugs.

A brain tumour can have a similar effect as well. If there are no signs of stroke, I'd consider an head scan.

[kittynurse]

Thanks midnightwriter   Things are little less scary today.  She called the nurses' line last night and they felt that since it had been 24 hours and she wasn't showing any signs that it wasn't necessary to rush to the ER (which surprised me because usually they pull the trigger on sending you pretty quickly).  Obviously they told her if she had any other symptoms she was to call 911 immediately.  So, she called her doctor's office this morning and they had received the report and booked an appointment for her for tomorrow morning (turns out the one I thought she had for tomorrow got rescheduled for 2 weeks from now).  Her actual doctor doesn't work on Wednesdays.

So, I will update after her appointment.  I have no doubt the doctor will order a CT scan, she did for me once when I had a weird headache.

Thanks for your advice everyone!

Martha

[deditus]

This sounds *exactly* like the seizures my mom had following an undiagnosed head injury in a car crash. The seizures didn't start until 9 months after the crash. They were finally diagnosed using outpatient monitoring, I don't remember what it's called, where you wear the electrodes to record the brain activity during a seizure (EEG?).

[mamacolleen]

It's very good she's getting in to get it checked out sooner rather than later. I'm a neurosurgery RN and that sounds exactly like a TIA. The thing with TIAs is that your risk of stroke goes up once you've had one. I would absolutely insist on a CT head to rule out anything else it might be (tumor, bleed, etc) but is highly unlikely that the scan would show any effect if it was a TIA. A TIA is transient, there's no lasting damage to the brain so you can't see anything on a scan. However, there are other tests a doc can do, and should do, based on your mum's history.

If the doc thinks it was a TIA, you and your family should familiarize yourself with all the warning signs of TIA and stroke. Here's a good start: http://www.nlm.nih.gov/medlineplus/ency/article/000730.htm

Hope it all works out.

[kittynurse]

Hi all!  Sorry for the delay in updating - it's taken a few days to get all the correct information and I've also been ticked at my mother's doctor and didn't really want to think about it.

So, she went for her appointment and the doctor agreed that a TIA was a strong possibility.  Gave Mum some requisitions for head CT, carotid artery doppler, chest echodoppler (I think - mum doesn't really understand this stuff), bloodwork, heart holter - I think that's it.

The doctor didn't advise my mother of any precautions to take (ie. tell my father to quit smoking!!!!) and sent her on her way saying she'll see her in a couple of weeks when the results are in.  She also didn't explain any of the requisitions other than to tell her she needs to arrange the appointments herself.  Which ticks me off because the req for the CT needs to be physically delivered to the hospital - a phone appointment cannot be made.  So, my mother should have walked across the street and dropped it off that day which would have gotten her on the waiting list immediately.  Instead she came home to our town which is 1 hour away and expected to just call everything in.

This used to be my doctor and aside from the distance I was really starting to dislike her because of her casual attitude towards stuff and reluctance to do anything.  Basically it felt like she was phoning it in and just biding her time until retirement.  She's not a bad doctor but not a great doctor in my opinion.

I'm also feeling guilty because I feel like I should have gone with my mother to the appointment.  Not that she would have let me go in with her but at least I could have tried.  My mother is of the generation that idolizes doctors and feels like they can do no wrong and she never ever questions anything and feels like she is being an inconvenience to the doctor.  That was probably obvious from the fact that I practically had to force her to call someone just to ask if she should be worried.

Man, I'm so pissed and I don't want to turn this into a rant.  I have already started laying to groundwork to convince my mother to switch to my doctor here in the town we live in.  She's resistant but this incident is really the straw that broke the camel's back for me and I'm not giving up.

Thanks for all the advice and encouragement folks.  I will update as I get more information.

Martha

[kittynurse]

Originally Posted by mamacolleen 

It's very good she's getting in to get it checked out sooner rather than later. I'm a neurosurgery RN and that sounds exactly like a TIA. The thing with TIAs is that your risk of stroke goes up once you've had one. I would absolutely insist on a CT head to rule out anything else it might be (tumor, bleed, etc) but is highly unlikely that the scan would show any effect if it was a TIA. A TIA is transient, there's no lasting damage to the brain so you can't see anything on a scan. However, there are other tests a doc can do, and should do, based on your mum's history.

If the doc thinks it was a TIA, you and your family should familiarize yourself with all the warning signs of TIA and stroke. Here's a good start: http://www.nlm.nih.gov/medlineplus/ency/article/000730.htm

Hope it all works out.

Thanks for posting this.  We are quite close to you.  The doctor is actually at Trillium (well, across the road) and we live in a small city about an hour west.  It was Telehealth that Mum ended up calling and I was really surprised that they didn't send her to the hospital.

Do you have any advice as to what she should do in the meantime for prevention while we wait for the results?  Other than convince my father that he really really needs to quit smoking this time?

Martha

[mamacolleen]

It's a small world. I work at St. Michael's!

It's too bad the doc didn't offer much more support. I think the tests the doc ordered are totally appropriate. They'll let you know what the cause of the TIA was. The CT head will rule out other possible causes of your mum's symptoms. The carotid dopplers will let you know if the TIA was caused by a blockage of the carotid arteries (they feed blood to the head) and if it was, by how much they're blocked. The echo and holter will be looking at your mum's underlying heart rhythms to see if she has something called atrial fibrillation, which is an abnormal heart rhythm that can cause tiny pieces of clot to temporarily lodge in the carotid arteries.

Generally the treatment, no matter the cause, would be for your mum to go on blood thinners. Is she on them already? If not, I would guess the doctor didn't put her on them right away in case there was another cause of the event (unlikely but the CT head will let you know for sure). Personally, I would try and book the tests all pretty quick and make an appointment with the doctor for as soon as the results are all in. The risk of another TIA or a stroke is highest in the first few weeks after the first one. I'm really surprised that telehealth didn't recommend going to the hospital right away.

I look after patients that sound like your mum all the time in terms of hesitation to seek medical care and belief in the almighty word of the doctor. I would really impress on her that if she has any other similar episode that she should go right away to the hospital. The best prevention right now is to memorize the signs in the link I first posted and to bring her in immediately if she experiences any of them again, no matter the time of day. Especially since she's had a first episode. Trillium is a good hospital for neurosciences but I would take her to the closest hospital and let them deal with transport. An hour can be a long time to wait for medical care in situations like this.

I can't really advise anything else since we don't know what caused the original episode. Does your dad smoke in the house? If he doesn't smoke in the house or car, then to be honest I probably wouldn't fixate on that too much. Unless you want to use this as an excuse to get him to focus on his own health too!

Good luck. Take care and let me know if you have any more questions.