Transient ischaemic Attack (Tia) Mini Stroke

[This Thing of Darkness]

I had one of these a few weeks ago , last about 5 minutes numb left hand kept dropping my bag and slurred speech , small blood clots mainly although they can stop oxygen getting to the brain they dissipate and you head comes back to normal quite quickly. I had a CT scan and the brain box looks ok a few scars here an there but nothing of new origin. What I found out when I did Neurologists question about symptoms is that I had TIA in Bangkok departure lounge about 5 months ago and didn't know it, same symptom's, numb left hand continuously dropping my passport and my speech went completely this is only for a few minutes and then you are back to normal. Neurologist wants me to have an MRA Brain scan (Not MRI) and an Ultrasound of Carotid artery

Been quoted 25000 at BKK Patt hospital , our company insurance covers it with state hospitals(Equivalent of NHS) Ive been told 3 months waiting list just for consultation, so I may have a dive in and do it myself, any one had this done or have a TIA themselves

Edited October 26, 2015 by This Thing of Darkness

[oncearugge]

What is your Nationality.

In my experience those who have suffered diagnosed TIA's are prioritised for investigations such as MRA/Carotid ultrasound.

I trust your doctor has prescribed some appropriate medication.

[This Thing of Darkness]

What is your Nationality.

In my experience those who have suffered diagnosed TIA's are prioritised for investigations such as MRA/Carotid ultrasound.

I trust your doctor has prescribed some appropriate medication.

Aspirin every day and anti anxiety tablets at first, might take one if I cannot sleep, I am british

[Sheryl]

I am not clear when you say your company's insurance covers this only at state hospitals are you referring to government hospitals in Thailand or back in the UK?

I have never seen an insurance policy like that, usually they just have a limit on how much they will pay and you pay the excess.

If you are talking about government hospitals in Thailand where is this information about 3 month wait coming from? You can certainly get a specialist consultation at a government hospital quickly especially if you use one that has a private channel. A TV member not too long back went to the Prasart Neuro Institute (a dedicated neurological govt hospital) and was very promptly seen and scanned. (may have been just MRI not MRA but I really don't think that is critical.)

And I very, very much doubt there would be a 3 month wait in the UK for someone with documented TIAs.

There are a number of TV members who have has TIAs and small strokes and been treated here in Thailand though I do not recall any doing so at BPH and the main Bangkok Hospital in Bkk would generally be the preferred private hospital (and might cost a little less).

You need to consider not just the cost of the diagnostic tests but the costs of the likely treatments that may be indicated as that can run far higher. Carotid endarterectomy if indicated is likely to run at least 300K at a private hospital. And should it be something more complex than that, could be looking at nearly a million.

[DogNo1]

Thanks. I looked up MRA and endardectomy. I have had what may have been small TIAs but none that caused me to lose any abilities. I have had ultrasound evaluations of my carotid arteries that were negative for obstructions. I don't want to overdo examinations that are not necessary. I woder if MRAs are indicated in the absence of significant symptoms. That said, I had a friend who gradually became less communicative as he aged. An autopsy showed that he had had many mini strokes that he apparently didn't notice. I'm afraid to bring up the question at Bumrungrad since they will immediately schedule me for expensive examinations. Any advice?

[oncearugge]

Thanks. I looked up MRA and endardectomy. I have had what may have been small TIAs but none that caused me to lose any abilities. I have had ultrasound evaluations of my carotid arteries that were negative for obstructions. I don't want to overdo examinations that are not necessary. I woder if MRAs are indicated in the absence of significant symptoms. That said, I had a friend who gradually became less communicative as he aged. An autopsy showed that he had had many mini strokes that he apparently didn't notice. I'm afraid to bring up the question at Bumrungrad since they will immediately schedule me for expensive examinations. Any advice?

Your physician will advise if a MRA is indicated.

As you say if the issue is raised by yourself there is a likelihood of your "request" being met.

[This Thing of Darkness]

Thanks. I looked up MRA and endardectomy. I have had what may have been small TIAs but none that caused me to lose any abilities. I have had ultrasound evaluations of my carotid arteries that were negative for obstructions. I don't want to overdo examinations that are not necessary. I woder if MRAs are indicated in the absence of significant symptoms. That said, I had a friend who gradually became less communicative as he aged. An autopsy showed that he had had many mini strokes that he apparently didn't notice. I'm afraid to bring up the question at Bumrungrad since they will immediately schedule me for expensive examinations. Any advice?

Your physician will advise if a MRA is indicated.

As you say if the issue is raised by yourself there is a likelihood of your "request" being met.

MRA 21000bt in BKK Pattaya ultra sound 4K

[Sheryl]

He's apparently already had the ultrasound. MRA cost at Bumrungrad likely to be about the same as at BPH. Whether it is indicated is another matter.

DogNo1, from what you say the diagnosis of TIA is not certain so that is the first issue. It would help to know more about the exact symptoms. Cardiac problems, for example, can cause momentary losses of consciousness, and are especially likely if there were no symptoms localized to just one side of the body. Atypical seizures can produce focal signs and easily be mistaken for TIAs . If you then saw a neurologist specializing in stroke, specialists tend to have tunnel vision and once having excluded a serious problem in their area of specialty will often fail to refer or even think of other causes.

So please describe exactly what these episode consisted of and also whether you have elevated blood lipids, diabetes, high blood pressure and any medications you take regularly.

If these truly were TIAs then more investigation would be prudent but does not necessarily have to be MRA...and a change of doctors might also be wise.

[This Thing of Darkness]

He's apparently already had the ultrasound. MRA cost at Bumrungrad likely to be about the same as at BPH. Whether it is indicated is another matter.

DogNo1, from what you say the diagnosis of TIA is not certain so that is the first issue. It would help to know more about the exact symptoms. Cardiac problems, for example, can cause momentary losses of consciousness, and are especially likely if there were no symptoms localized to just one side of the body. Atypical seizures can produce focal signs and easily be mistaken for TIAs . If you then saw a neurologist specializing in stroke, specialists tend to have tunnel vision and once having excluded a serious problem in their area of specialty will often fail to refer or even think of other causes.

So please describe exactly what these episode consisted of and also whether you have elevated blood lipids, diabetes, high blood pressure and any medications you take regularly.

If these truly were TIAs then more investigation would be prudent but does not necessarily have to be MRA...and a change of doctors might also be wise.

Apologies for late response, been in a meeting. I was unaware that I'd actually had one of these, My "Attack" and visit to the Doctor and the made me realize. The symptom from a week ago were my computer going very bright, I stood up and leant on table as I felt I was going to fall out of the chair Walked out of the office , had very small bag of shopping with me, as I walked towards the station I kept dropping it from my left hand which was numb , got in a Taxi at the station and the driver could no understand my slurred speech at the station my senses seemed to be coming back , not speech though so I had to write address down, Similar to incident in airport a few months back . Kept dropping passport left hand, called the missus and couldn't talk , went away in minutes and I carried on with my journey Will message you reports

[Sheryl]

Yes, yours clearly were TIAs and more investigation would be prudent as per my prior post, but you need to consider not only the cost of the tests but of the possible treatment. And get clarification on the insurance issue. If it truly covers you only at government hospitals in Thailand then I suggest the Prasert Instititute which is a specialized neruo hospital in Bangkok. http://pni.go.th/pnigoth/

the question about symptoms was for DogNo1 whose case seems less clear cut.

[aneliane]

TIA: The most effective, safest and inexpensive way out:

The most effective, safest, and inexpensive way to “thin” the blood and prevent blood clots that cause heart attacks and strokes is to avoid the most powerful blood-clotting substances people contact daily, which are animal (saturated) fat and hydrogenated “trans” fats.By avoiding meat, poultry, eggs, dairy products, and processed foods people naturally and safely thin their blood and prevent tragedies with no side effects, no extra costs, and no rebound effects. Plus this no-cholesterol, low-fat diet is the same one that heals the underlying artery disease, atherosclerosis, and improves overall health and longevity.

https://www.drmcdougall.com/misc/2010nl/apr/aspirin.htm

[oncearugge]

Yes, yours clearly were TIAs and more investigation would be prudent as per my prior post, but you need to consider not only the cost of the tests but of the possible treatment. And get clarification on the insurance issue. If it truly covers you only at government hospitals in Thailand then I suggest the Prasert Instititute which is a specialized neruo hospital in Bangkok. http://pni.go.th/pnigoth/

the question about symptoms was for DogNo1 whose case seems less clear cut.

+1

The insurance cover does need to be clarified.

There remains an option of returning to the UK . If you do this make sure to obtain copies of all the Thai medical notes, lab and x-ray/scan reports to take home.

[This Thing of Darkness]

Yes, yours clearly were TIAs and more investigation would be prudent as per my prior post, but you need to consider not only the cost of the tests but of the possible treatment. And get clarification on the insurance issue. If it truly covers you only at government hospitals in Thailand then I suggest the Prasert Instititute which is a specialized neruo hospital in Bangkok. http://pni.go.th/pnigoth/

the question about symptoms was for DogNo1 whose case seems less clear cut.

Government hospital in Singapore , 2 different things of course, Fine hospitals but waiting lists galore. If I was an in patient needing treatment They pay 80% for 60 days. Seems that most scans in Thailand are cheaper, about 500gbp for MRA and Ultrasound in Bangkok Pattaya Hospital. Neurologists letter he has MRA and/or Ultrasound in main artery area, should I get both ? Whats the difference with MRI to MRA.

I'm trying to remain confident about this , obviously I have my weaker moments at time , Ive given up reading "Health" sites on the web, some will tell me I'm on the border of immediate death others , sometimes they just go away. My stress levels have been up for years, my job can be pretty relaxing when going well interrupted by spells of manic action and decision making. Ive developed quite a healthy temper and see a Trick Cyclists once a week (Anger Management) I think we are too different for him to help , I'm from a rough hole in east London 48y/o, he sort of late 20s and had a very nice life with no sex , drugs and violence involved.

I also have had what I believe to be an imaginary mild headache. Work meetings a nightmare very garbled and loud which sort of makes my head spin , cant take it all in and I start to think I'm going to have another one.

After first scan Neurologist is quite confident my head is ok, and it may be linked to extreme stress and quickly on setting Hypertension (Both situation of TIA I was in a stressful situation. ) I have old minor "Infarctions "and a tasty scar on the left side of my brain from a misspent youth (Wood saw 15 stitches). There is something going on with my spelling its not too bad usually , but in many cases I'm writing half the word and then starting the next one , I only notice when I read back. Should know what's going on Next Friday, If its scabby artery then obviously its do able

[oncearugge]

Yes, yours clearly were TIAs and more investigation would be prudent as per my prior post, but you need to consider not only the cost of the tests but of the possible treatment. And get clarification on the insurance issue. If it truly covers you only at government hospitals in Thailand then I suggest the Prasert Instititute which is a specialized neruo hospital in Bangkok. http://pni.go.th/pnigoth/

the question about symptoms was for DogNo1 whose case seems less clear cut.

Government hospital in Singapore , 2 different things of course, Fine hospitals but waiting lists galore. If I was an in patient needing treatment They pay 80% for 60 days. Seems that most scans in Thailand are cheaper, about 500gbp for MRA and Ultrasound in Bangkok Pattaya Hospital. Neurologists letter he has MRA and/or Ultrasound in main artery area, should I get both ? Whats the difference with MRI to MRA.

I'm trying to remain confident about this , obviously I have my weaker moments at time , Ive given up reading "Health" sites on the web, some will tell me I'm on the border of immediate death others , sometimes they just go away. My stress levels have been up for years, my job can be pretty relaxing when going well interrupted by spells of manic action and decision making. Ive developed quite a healthy temper and see a Trick Cyclists once a week (Anger Management) I think we are too different for him to help , I'm from a rough hole in east London 48y/o, he sort of late 20s and had a very nice life with no sex , drugs and violence involved.

I also have had what I believe to be an imaginary mild headache. Work meetings a nightmare very garbled and loud which sort of makes my head spin , cant take it all in and I start to think I'm going to have another one.

After first scan Neurologist is quite confident my head is ok, and it may be linked to extreme stress and quickly on setting Hypertension (Both situation of TIA I was in a stressful situation. ) I have old minor "Infarctions "and a tasty scar on the left side of my brain from a misspent youth (Wood saw 15 stitches). There is something going on with my spelling its not too bad usually , but in many cases I'm writing half the word and then starting the next one , I only notice when I read back. Should know what's going on Next Friday, If its scabby artery then obviously its do able

Oh Dear ..................

I will just answer one point for you.

MRA is an acronym for "Magnetic Resonance Angiogram" which means it is a scan which specifically highlights blood vessels.

I am sure Sheryl will provide further advice

.

[Sheryl]

Would have been useful to know from the start that you are in Singapore.

If I understand correctly, you are already being treated by a Neurologist there and have already had a CT which was clear but the neurologist advises you also get a carotid ultrasound and MRA. You have insurance cover at government hospitals in Singapore (which is presumably where you have been seen already by a neurologist?) but there is a long wait for an MRA there so are considering coming to Thailand for it. Is that correct?

I don't really understand why the ultrasound is an issue as it is a simple procedure that can usually be done by the neurologist himself in his office.

An MRA is a type of MRI done with the same machine but giving a better view of the arteries. Only a few places in Thailand can do it and not unusual for there to be a backlog for it in government facilities.

At 48 it is worth having a thorough evaluation because there is a greater chance of something out of the ordinary ("ordinary" in the sense of age-related hardening of the arteries and accumulation of placque) being to blame. If your neurologist feels that an MRA is what would be most helpful (and given that you already had a CT) then I would go ahead with that. And given that you would be coming to Thailand only for the test with the neurologist back in Singapore being the one to review the film and plan treatment, selection of a doctor and hospital here is less important than it would otherwise be.

The least expensive source for those who need only the scan (i.e. already have a doctor who will review it) is this place in Bangkok which is a stand alone imaging facility:

http://www.mrithailand.com/index.php?modules=article&id=4

It is located not too far from Don Muang airport so convenient if you come in by Air Asia, whcih is also usually the least expensive air fare

I am reasonably sure, but not positive, that they can do MRA. To avoid any confusion when you communicate with them I suggest you spell out "MR Angiography" so that it is not confused with regular MRI. English speaking capacity there is not the greatest but if you persevere you'll be able to manage and it may save significant amount of money.

I also suggest you check the cost at these two hospitals in Bangkok as they may be a little less than BPH:

http://www.bangkokhospital.com/index.php/en

https://www.bumrungrad.com/

http://www.siphhospital.com/en/index.html

All three can do MRA. The third will usually be the least expensive of the three but is also less conveniently located being on the Thonburi side of the Chao Phya river (but not too far from the area around the Grand Palace). With them as with the stand alone imaging center best to spell out "MR angiography" to avoid any misunderstanding and also tell them clearly you already have a neurologist in Singapore and thus need only the test, not a consultation.

I suggest you also discuss with your neurologist whether an EEG would be advisable since sometimes atypical seizures can produce symptoms similiar to a TIA. Another thing that needs exclusion is atypical migraine headache. That last has no particular diagnostic test and has to be based on exclusion of other causes and clinical presentation. But EEG can be helpful in excluding atypical seizures. Especially given your history of past head trauma, and your age (which is on the young side for TIAs), this should be considered.

Lastly before coming to Thailand for tests, even though the plan is to then go right back to Singapore it would be well to find out whether your insurance would cover emergency care in Thailand should you have an acute event while here, either spontaneously or as a complication of the MRA (rare but can happen - usually as a reaction to the contrast material which has to be injected).

As to worrying I think at this point the diagnosis is still up in the air so try to defer it until you know what you are dealing with. Easier said than done, but no point getting worked up over something that may not even be what you have.

[This Thing of Darkness]

Thank you, when I realized I'd had the same thing happen 4 months ago in Bangkok I became quite pessimistic, I though it was a one off before I remembered or realized what it was that happened, As the brainbox is pretty clear I think Neurologist is convinced its something going on in my blood. My consultancy fees are around 200sd and hour, its likely the company insurance with cover it. Could TIA be caused by Hypertension ? Ive been in a stressful situation on both occasions

[Sheryl]

Not directly caused by it in the immediate sense, but high BP is a risk factor for it (if poorly controlled over time it will stiffen the blood vessels). And, most importantly, uncontrolled high BP is a major risk factor for the most serious kind of stroke, and having had TIAs you are at elevated risk of stroke, this is actually the main worry. So if you have hypertension it is essential to keep your BP well controlled.

However, while stress will cause a temporary rising of the systolic BP, that is not the same thing as having hypertension. Stress per se cannot cause a TIA (if it could we would all have them from time to time). However chronic stress over long periods of time can contribute to other problems such as hypertension which can in turn be risk factors for TIA and stroke.

Acute stress can also causes migraines and as I mentioned atypical migraine (without the characteristic pulsating headache, but with neurological changes) is a possibility you should ask your neurologist about.

[This Thing of Darkness]

Not directly caused by it in the immediate sense, but high BP is a risk factor for it (if poorly controlled over time it will stiffen the blood vessels). And, most importantly, uncontrolled high BP is a major risk factor for the most serious kind of stroke, and having had TIAs you are at elevated risk of stroke, this is actually the main worry. So if you have hypertension it is essential to keep your BP well controlled.

However, while stress will cause a temporary rising of the systolic BP, that is not the same thing as having hypertension. Stress per se cannot cause a TIA (if it could we would all have them from time to time). However chronic stress over long periods of time can contribute to other problems such as hypertension which can in turn be risk factors for TIA and stroke.

Acute stress can also causes migraines and as I mentioned atypical migraine (without the characteristic pulsating headache, but with neurological changes) is a possibility you should ask your neurologist about.

Thanks , Funnily enough Ive had what I though was a kind of phantom headache on the sides/crown of my head , doesn't hurt much but sort of feels a bit sore

[This Thing of Darkness]

Amazingly I got a referral from the GP for Singapore National Hospital and I am booked to see neurologist on 3/11/15. I was supposed to meet with the deputy CEO of my company at 5-30. Might be able to make both but the Hospital comes first

[evadgib]

This caught my eye today from the British Govt:

World Stroke Day: new public awareness film released

[oncearugge]

This caught my eye today from the British Govt:

World Stroke Day: new public awareness film released

Good sound advice but just the vid. is new.

The FAST acronym has been promoted for some time.

[chubby]

neurologists are a funny specialty, i think doctors, if there is any doubt would like to have a MRI, sort of like how they use antibiotics, but then if anything does show up, you'd be glad you did it, no downside but the cost. ; if it ends up being recommended to do endartectomy, do some homework , my understanding is those were way overdone, and the risk/benefit wasn't what many smart doctors thought it was in the USA here, not so long ago ......

http://www.rightdiagnosis.com/sym/hemiparesis.htm

http://www.merckmanuals.com/professional/neurologic-disorders/stroke-cva/transient-ischemic-attack-tia

btw, guess i have to ask what is "this thing of darkness" ?

Edited November 1, 2015 by chubby

[This Thing of Darkness]

neurologists are a funny specialty, i think doctors, if there is any doubt would like to have a MRI, sort of like how they use antibiotics, but then if anything does show up, you'd be glad you did it, no downside but the cost. ; if it ends up being recommended to do endartectomy, do some homework , my understanding is those were way overdone, and the risk/benefit wasn't what many smart doctors thought it was in the USA here, not so long ago ......

http://www.rightdiagnosis.com/sym/hemiparesis.htm

http://www.merckmanuals.com/professional/neurologic-disorders/stroke-cva/transient-ischemic-attack-tia

btw, guess i have to ask what is "this thing of darkness" ?

Its from Shakespeare's The Tempest .Also the tittle of a really excellent book to do with Darwin but more about Robert Fitzroy the captain of the Beagle , whos family were very wealthy and members of the British establishment. Devout catholic and creationist. Its a touching , funny , sad, true story

Edited November 1, 2015 by This Thing of Darkness

[This Thing of Darkness]

Going to Thailand in the morning and Bangkok Pattaya Hospital in The afternoon , MRI and Ultrasound. I have had a CT scan , all good , but I have been told MRIs see more by one Neurologist and others say if a CT is good an MRI will be, The first neurologist I saw after the CT said I should have an MRA scan. Be at home until the 12th for deepavali

[This Thing of Darkness]

Had MRA of chest neck and Brain. Arteries fine. He did mention a mild case of Hydrocephalus, or too much spinal fluid in the Brain , guess what lucky boy is going Have Lumbar Puncture to get it out on the 27th ?

[oncearugge]

Had MRA of chest neck and Brain. Arteries fine. He did mention a mild case of Hydrocephalus, or too much spinal fluid in the Brain , guess what lucky boy is going Have Lumbar Puncture to get it out on the 27th ?

An LP will not "cure" hydrocephalus

What reason was given in explanation for the Hydrocephalus?

If there was no explanation one should be sought prior to agreeing to an LP.

[This Thing of Darkness]

Had MRA of chest neck and Brain. Arteries fine. He did mention a mild case of Hydrocephalus, or too much spinal fluid in the Brain , guess what lucky boy is going Have Lumbar Puncture to get it out on the 27th ?

An LP will not "cure" hydrocephalus

What reason was given in explanation for the Hydrocephalus?

If there was no explanation one should be sought prior to agreeing to an LP.

How it was explained to me was the LP is part of the diagnosis's, to establish what type of hydrocephalus it is

[Sheryl]

I too question the LP, usually done only when intracranial bleeding or infection are suspected to have caused the hydrocephalus neither of which seems likely in your case (the imaging would have ruled out a bleed, and you have no symptoms suggestive of infection).

Also question the MRA of the chest.

You need to be careful you are not being subject to excessive and unnecessary tests. Known to happen.

[This Thing of Darkness]

I too question the LP, usually done only when intracranial bleeding or infection are suspected to have caused the hydrocephalus neither of which seems likely in your case (the imaging would have ruled out a bleed, and you have no symptoms suggestive of infection).

Also question the MRA of the chest.

You need to be careful you are not being subject to excessive and unnecessary tests. Known to happen.

For the chest 2 Singaporean Neurologists suggested the TIAs could be caused by damaged or hardened Arteries. My old man had his first attack on Angina at 40 years old. I Have the resources to be to able to undertake most tests they feel are adequate. I don't sit there worrying thinking ohhhh I spent 2 Grand , I'm relieved I've not got a tumor or cancer and I've not just seen my wife and kids for the last time, If I'm going to "Spend" Money I'd rather do it taking care of myself than some stupid 20 K car or ridiculous over priced ex-council house. It seems the accumulation of money for the kids "Futures" is all what life is about , how about taking care of yourself and "Spending"" dough on that so you are around when they have their kids. I will not agree to the suggestion I am being Naïve. I suppose I could have spent the money on 2 weeks in Magaluff. If you are British as I am , I think we take free Government treatment for granted as we do with all government "Services"

[Sheryl]

Of course TIAs can be due to problems with arteries...the cerebral or carotid arteries. Not arteries in the chest.

It is not the case that having a lot of tests and spending a lot of money necessarily means you have safeguarded your health. In fact sometimes quite the opposite.