Repeated short-duration numbness of one side of body: prompt management can prevent a disabling disease
1. 51-year old Mr K presented with three episodes of numbness of left side of face, arm and leg in the past 20 days. Each episode lasted only 10 minutes.
#MedTwitter
1. 51-year old Mr K presented with three episodes of numbness of left side of face, arm and leg in the past 20 days. Each episode lasted only 10 minutes.
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2. Mr K also had feelings of tingling sensation in the affected areas. He had no weakness and could move his left arm & leg normally during those episodes. His speech also remained normal.
After 10 min, he used to have complete recovery from numbness and tingling.
#neurotwitter
After 10 min, he used to have complete recovery from numbness and tingling.
#neurotwitter
3. Mr K was a healthy person, with normal weight and BMI. He had no known medical illness. However, he consulted me for expert opinion.
The history was very typical of a neurological problem. Clinical examination was normal. I asked for appropriate investigations.
The history was very typical of a neurological problem. Clinical examination was normal. I asked for appropriate investigations.
4. Blood tests revealed the following abnormalities: Very low vitamin B12 and D, high homocysteine, high total and LDL cholesterol; high triglyceride. HbA1C level was normal.
These abnormalities were all risk factors for the disabling neurological disease, I was suspecting.
These abnormalities were all risk factors for the disabling neurological disease, I was suspecting.
5. MRI brain was normal. MR Angiogram showed narrowing of right posterior cerebral artery (PCA). Now the diagnosis was confirmed: Recurrent pure sensory transient ischemic attacks (TIAs).
If left untreated, many of these patients can develop #stroke.
If left untreated, many of these patients can develop #stroke.
6. Pure sensory TIAs strongly suggest the presence of PCA disease. Repeated compromise of small vessels supplying the posterior-lateral part of the thalamus seems to be the pathogenic mechanism.
(Ref: Cerebrovasc Dis 2002;14:136–138)
(Ref: Cerebrovasc Dis 2002;14:136–138)
7. I started Mr K on appropriate medical treatment, including antiplatelet and statins. Also counselled him about #healthylifestyle, #sleep and #exercise .
8. Take home message
Repeated episodes of stereotyped numbness or tingling sensation affecting one half of the body could be due to compromised blood supply to right side of brain (thalamus) and could be suggestive of TIA. Prompt evaluation and management can prevent stroke.
Repeated episodes of stereotyped numbness or tingling sensation affecting one half of the body could be due to compromised blood supply to right side of brain (thalamus) and could be suggestive of TIA. Prompt evaluation and management can prevent stroke.
Mr K was a strict vegetarian and his vitamin B12 was very low (20; normal in our lab is >70). As there are no good sources of vitamin B12 in vegetarian diet, I advised vitamin B12 supplements to him.
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