Sunday, January 02, 2011

What to do if you have weird symptoms, and what happens next.

Auntie Jo has news for everybody: Most people who have strokes, whether transient ischemic attacks (TIAs, where the blood flow to a part of your brain is restricted temporarily) or not-transient ones, ignore the symptoms, hoping they'll go away. This is bad for a couple of reasons: First, you never know when the symptoms are going to worsen from inconvenient to life-threatening; second, if you show up at an emergency room with a stroke early enough, we can prevent a lot of permanent damage.

So: If you have weird symptoms including (but not limited to) weakness or numbness on one side of the body, difficulty balancing, vision or speech changes, or anything that just doesn't feel right, call 911. Don't go to bed and sleep it off; don't drive yourself to the ED (geez m'knees). Don't have a shot of Beam and hope it goes away, don't take six aspirin and call your doctor for an appointment next week. Got it? Good.

When you do show up at the ED, you're probably wondering what we're going to do to you. Listen up and be enlightened so things won't seem so scary:

Once you describe your symptoms to the triage nurse, he or she will (if she or he is in posession of a reasonable number of brains) get you back to the treatment area pretty quickly. You'll have a neurological exam that tests, among other things, your ability to speak, move all your limbs, see things all over your field of vision, and interpret situations.

You'll have to have a head CT scan, I'm afraid. This is because those of us in the brain business want to know, sticklers that we are, whether or not you're bleeding into your brain or have a clot in it. If your head CT doesn't show anything exciting, we can assume that you're not bleeding ('cause blood shows up like gangbusters on a CT) and can treat you for a presumed clot.

If you've presented to the ED soon enough (within 3 hours of the onset of symptoms in most places), we can start you on a clot-busting drug called TPA. It's given IV in a drip and schlorps around your body for several hours, hopefully knocking out the clot that's in your brain without doing any other damage. Yeah, there are risks, which usually involve unpleasant bleeding we don't want, but it's generally a case of less risk than potential benefit.

You might get an MRI as well, probably sooner rather than later, if you have any symptoms of bleeding, or if things aren't cut-and-dried.

You'll also get, at some point, a couple of exams to be sure your heart is doing what it ought to. This is because one of the biggest causes of stroke is a clot that travels from the heart thanks to something called atrial fibrillation.

Atrial fibrillation (or "A-fib" if you're cool like me) is a condition in which the top half of the heart, rather than beating regularly, sits there and vibrates, wagga-wagga-wagga. This allows blood to pool in there and clot, and then, if and when your heart actually manages a good solid beat, those clots go flying up into your unhappy brain.

We would do an EKG to check the rhythm of your heart, as well as an echocardiogram. That last is basically a sonogram of your heart that lets us know for sure that you don't have any holes in your ticker or weird shunts or craziness like that.

All of this is necessary because neurology is primarily done by exclusion: we knock out all the things that *could* be wrong with you (like neurosyphillis, alien abduction, or a bleed) and end up, we hope, with something that really *is* wrong with you. Incidentally, this is also how neurology differs from neurosurgery: neurosurgeons have you hop up on the table so they can root around in that ol' brain box and find something definite.

Anyway: If you're not feeling normal, and it's not a hangover, go to the bloody ED, okay? It'll make both of our lives easier in the long run. It'll also mean I haven't wasted my valuable time by typing all this shizznit out.


Estelle said...

This post ought to be printed out, have 20million copies of it made, and then leafletted (is that a word? It sounds more offical than "dropped")from a helicoper over all major cities in order for it to be spread to the masses. Wisdom like this is too great to be confined to the interwebs.

rnraquel said...

Aw, Auntie Jo, I wish we could make this required reading for everyone. YOu don't know how many times I have been working in the ED and in comes someone with Grandma, whose speech has been slurred for "a couple of days". Or Paw Paw, who has had right sided weakness for a week. This made me crazy!!!

Anonymous said...

"This allows blood to pool in there and clot, and then, if and when your heart actually manages a good solid beat, those clots go flying up into your unhappy brain."

Or into your lungs, which isn't a whole lot better. That's what happened to my Mom a year ago November. As if lung cancer wasn't enough.... :(

Gretchen said...

One of the unfortunate things about bodies is that sometimes weird stuff is just weird stuff, or slightly-bad stuff presenting weirdly. But it's always best to err on the side of caution - even if it means that you have an experience like mine, which was:

Me: *checks in to ER with sudden-onset severe headache*
...a CT scan later...
Them: "Well, you're not bleeding, and otherwise seem fine, so... take some painkillers and call your doctor if things get worse"

It left me feeling rather foolish, and my parents with what I'm sure was an ugly ER bill. But I'm still glad I went in, because I like my brain how it is, thanks very much.

And I think I sent you an email about my fiance's UTI that looked like meningitis, which was a not-fun night for all involved, but again, I'm glad we went.

messymimi said...

Great advice. Especially for the stubborn among us (cough, cough, waited until it was pneumonia with pleurisy rather than just pneumonia thinking it would clear up).

If i feel any of those things, i will hie me straight to the ED, cross my heart.

Anonymous said...

I took myself to the ED a few years ago (oops, sorry, I just realized I drove--won't do that again) because of an odd sensation in my head. It felt like someone was trying to inflate it with a bicycle pump. It scared the doo-doo out of me.

Anyway, everything eventually checked out fine, and their best guess was vasovagal syncope.

Have a very happy New Year, Jo.

--Queen Anne's Lace

Allison said...

So, if one goes to the hospital with an arrhythmia, should the hospital check one for clots flying hither and yon? I went, they did the EKG (normal by the time they saw me) but no mention of potential clots in the brain. Is there a procedure for that?

Jo said...

AM, momentary arrhythmias generally won't send clots flying up and about--it takes several weeks for clots to form in the case of Afib.

Unfortunately, there's no test for brain clots until they, well, happen. Sadly.

Allison said...

Thank you for the response. I've not been able to get a clear idea of what the time line for the stroke would be.

clairesmum said...

And if you see this happening to someone, get them to the ER or at least call their MD office - or call their family - often the person who is having these symptoms is NOT fully aware of what is happening and the implications. Letting that person make the decision of whether/when to seek medical attention is a bad idea. I have a (now retired due to disability) coworker who was having some of these sx at work, but no one who was around wanted to cross her when she minimized what was happening!

petey said...

my mother (an RN, btw, so you'd think she'd know better) had what turned out to be a TIA but it was looking like a stroke when i got to her and i can't describe what a struggle it was getting a resisting mother into the cab and to the emergency room. when she could speak again they asked cognitive test questions including "who's the president?" answer: "george bush. he's kept us safe all these years", so maybe she wound up losing a little something. of course she never thanked me.

(first post, great blog, glad you, the blogger, are recovering)

inkgrrl said...

Thank you - always good to get the reminder ;-)

I have an arachnoid cyst behind my left eye that could produce many of the same symptoms if it decides to go poof. It's amazing how many things we have tucked away in our nooks and crannies.