Creator: Dr. Shivam Om Mittal
Published: 2017-07-01T08:30:15-04:00

Q. Are my mother's symptoms indicative of a stroke or something serious?

Patient's Query

Hi doctor,

My 58 years old mother is under treatment for hypothyroidism, hypertension, osteoarthritis of knee joints, and mild anemia. Her hemoglobin is 10.5 to 11.0 g/dL. She is currently on the following medicines, Eltroxin 50 mcg, Olmezest 20 mg, Gemcal D3, Uprise XT, and Folvite. Six months back, one day after breakfast, she had reported an incident of reeling of head and darkness in eyes, which got normalized after she laid down on the bed. She also had a fever (100 to 101 F) with cold and cough that time, which took 3 to 4 days to settle down with antibiotics.

One day after lunch, she again reported reeling of head and darkness in eyes, after which she got bent towards left side with her left-hand palm shaking for 15 to 20 second. And she was almost about to fall, which was stopped by us. She seemed to be in a subconscious state for 3 to 4 minutes, and she stared at something during that time. When we attempted to talk to her, initially she could make out only some sounds, followed by normal words, but in a strange voice, which got normal the next moment. However, coming back to sense, she was worried about the ongoing health issues of her son, and she had no memory of the incident at all. She was back to normal activities in next 10 minutes, and she did not report any arm or leg pain during that time. She also had a little cold the previous day, for which she took Cetirizine tablets.

We consulted a doctor after 5 to 6 such incidents, who mentioned this as a case of sodium and potassium imbalance due to viral infection. He also examined her physically, and he said that her BP is 122/82 mmHg. As there was no history of convulsion, as well, without ordering for any further investigations. However, I would like to summarize a few symptoms as follows, which keep me worried. She reported feeling very tired and sleepy until at least two weeks of the incident. She had quite a few occurrences of constipation followed by gastritis 5 to 6 times of motion along with weight loss in the last 3 to 4 months. After the day of 5 to 6 times of motion, she reported feeling heaviness in legs, difficulty in walking along with a severe headache right from the morning. When we reported this to our doctor, he asked to test her sodium (138.4 mEq/L) and potassium (3.72 mEq/L) levels, which came back normal.

Since the last couple of months, she felt a significant increase in her left knee joint pain, which I am not sure if totally because of existing osteoarthritis or not. Since the last couple of months, she felt difficulty in lifting heavy objects, especially, with the left hand and to some extent with right hand too. I have attached her recent routine test reports along with the doctor's prescription. Could you please review the incident along with the reports? Is it a stroke or TIA or something serious?

Answer

Dr. Shivam Om Mittal

Neurology

Hi,

Welcome to icliniq.com.

Thank you for your question. You have described your mother's symptoms very well.

The "reeling in the head and shaking" with change is position or posture is a typical symptom of orthostatic hypotension. There is an easy bedside test that you could also perform. Check blood pressure while in laying position, sitting and standing position. If the values are close enough, that is normal, but if there is a difference of more than 20 or 10 mmHg in systolic and diastolic respectively, it is suggestive of orthostatic hypotension.

It has a specific treatment and can be treated very well. Any illness and low hemoglobin can predispose to have low blood pressure on standing (orthostatic hypotension). This can cause syncope or lose consciousness for few seconds with a sudden upright position, which gets better when she lays down.

There are two things I am concerned about, and it will be difficult to narrow down the differential without a neurological exam.

The left-hand shaking followed by loss of memory of the event and not able to return to her normal self for two weeks after this episode.
Early morning headaches, which I assume are new onset.

Based on these two symptoms, I would recommend getting a thorough neurological examination looking for any left-sided weakness or sensory findings. In any case, I would get MRI brain to make sure there is no tumor causing a focal seizure or convulsion.

Yes, low sodium can provoke a seizure, and it was important to check it. But I would also check kidney function panel and liver function test. Also, get an ECG (electrocardiogram) test.

I will be happy to answer any other questions you have.

For further queries consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

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Patient's Query

Hello doctor,

Thank you for the response. I would like to clarify a few more things, just in case they give any further clue. Both incidents had happened in sitting position itself. There was no change in position before she got a dark vision. The early morning headaches had happened only after the day she had 5 to 6 times of motion (not loose motion). This is not a daily symptom. Symptoms like the increase in left knee joint pain and difficulty in lifting heavy objects through the left hand are persistent since past couple of months. Her KFT tests were done last year, which mostly came normal (BUN was 14 and creatinine is 0.8), although LFT was not yet done. Based on the details we know so far, can I request your advice on kind of incident it had been? Was it a stroke or TIA? Were the sodium (138.4) and potassium (3.72) levels fine? What do you feel the cause of too much fatigue and sleepiness for a couple of weeks after the incident?

Answer

Dr. Shivam Om Mittal

Neurology

Hi,

Welcome back to icliniq.com.

Thank you for the clarification.

Based on the further information, this seems unlikely to be a seizure. If the headache symptoms or left arm shaking spells recur, then definitely get an MRI of the brain. Constant fatigue and tiredness can happen with low blood pressures and anemia.

I would recommend checking for blood pressures in the different position, as I mentioned in the previous answer. Also, Holter monitor and tilt table testing for autonomic testing could be performed if available.

Yes, the sodium and potassium are normal. If she has worsening of joint pains along with fatigue symptoms, I would check with a rheumatologist and check ANA (antinuclear antibody), rheumatoid factor, and other tests to look for evidence of any autoimmune condition. But truly, before ordering the tests, she should have a thorough clinical examination.

TIA (transient ischemic attack) is a mini stroke where symptoms happen for few hours, and then the patient normalizes. It is atypical for a stroke to present with reeling in head and darkening of vision. Stroke causes irreversible damage to the brain with weakness, slurred speech, and facial asymmetry. Thus if the neurological exam is normal, then unlikely it is a stroke. Stroke or TIA should not cause worsening of joint pains.

For further queries consult a neurologist online --> https://www.icliniq.com/ask-a-doctor-online/neurologist

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