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Ask Dr S.A.Alam Your Own Question
Dr  S.A.Alam
Dr S.A.Alam, Doctor
Category: Medical
Satisfied Customers: 4469
Experience:  MBBS/FCPS(R)/MRCP(R) U.K
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My son Amrik Ahluwalia has had a mini stroke in the past due

Resolved Question:

My son Amrik Ahluwalia has had a mini stroke in the past due to migranes . He was examined at watford and was cleared the same day. He has had another attack but his left side has lost movement and not the right. He has not lost his speech as much and is resting at the moment
Please advise
Submitted: 2 years ago.
Category: Medical
Expert:  Dr S.A.Alam replied 2 years ago.
Dr S.A.Alam :

Hello, Welcome to JustAnswer and thank you for your question.

Dr S.A.Alam :

Is he at a hospital now ?

Customer:

no he is at home

Dr S.A.Alam :

are these symptoms of weakness new

Dr S.A.Alam :

or they were present when he was examined by doctor

Dr S.A.Alam :

in the hospital ?

Customer:

difficult to tell he is asleep the only symptoms before goingto sleep was that he could not chew his lunch on the left side of his mouth and numbness in his left fingers and could not hold anything

Dr S.A.Alam :

These are not symptoms of a minor stroke this is a full stroke

Dr S.A.Alam :

He needs to be hospitalized if he is unable to move his left side or part of mouth

Dr S.A.Alam :

he needs blood thinner medicine and CT scan of not already done within 24 hours

Customer:

when he was last at the hospital all his symptoms healed within the hour

Dr S.A.Alam :

These symptoms with a history of migraine can be due to PFO

Dr S.A.Alam :

PFO is a small hole in the heart which normally does not effect the heart function.

Dr S.A.Alam :

it makes blood clots from legs to move to brain and this may be the possible cause which is being missed in his case.

Dr S.A.Alam :

So admission in hospital and echocardiogram should be considered.

Customer:

He has now got movement back in his fingers and in his mouth will the echocardiogram be relevent

Dr S.A.Alam :

if these symptoms of stroke of mini stroke are happening again and again then these cannot be simple be due to migraine,

Dr S.A.Alam :

In most of these cases i have seen that a diagnosis of PFO is made years after his symptoms.

Dr S.A.Alam :

because PFO is a small hole between upper chambers of heart

Dr S.A.Alam :

it is missed normally unless you are seeing for it specifically.

Dr S.A.Alam :

It can be close without an operation

Dr S.A.Alam :

it will stop his migraine and stokes

Dr S.A.Alam :

In his case if his previous CT scan brain, neck and doppler scan of neck arteries are normal

Dr S.A.Alam :

then PFO is a very possible diagnosis.

Dr S.A.Alam :

PFO and ASD both can cause this, ASD is almost same to PFO.

Customer:

does he have to go immediately to have this or do we just get reffeered throught the gp as his previous ct scans were all normal

Dr S.A.Alam :

As he is having these episodes of stroke again and again so it is best to take him to his GP ASAP

Dr S.A.Alam :

GPs mostly miss PFO because they are nor trained for this.

Dr S.A.Alam :

A cardiologist is a best doctor who can give a best opinion on this case.

Dr S.A.Alam :

neurologist and cardiologist are the doctors whom he should be visiting.

Dr S.A.Alam :

not a GP

Customer:

He is booked this afternoon for 4.50 is that soon enough and if they are not trained what am i asking them to check

Dr S.A.Alam :

This seems ok

Dr S.A.Alam :

they are only trained for general symptoms

Dr S.A.Alam :

while this case needs specialty doctors.

Dr S.A.Alam :

you can simply ask him and tell him about our chat.

Customer:

will the gp refer us to the appropriate neurologistgist or cardiologist

Dr S.A.Alam :

I have worked in UK it is very slow system.

Dr S.A.Alam :

yes he can do that but you have to stress on it and tell him to treat it as emergency case.

Dr S.A.Alam :

as he is at risk of more stroke attacks which might not be small or minor.

Dr S.A.Alam :

Let me know if you have questions.

Customer:

what does PFO , ASDstand for

Dr S.A.Alam :

patent foramen ovale

Dr S.A.Alam :

and atrial septal defect.

Dr S.A.Alam :

I hope this answers your questions.

Dr S.A.Alam :

Let me know if you have queries.

Dr S.A.Alam :

Do rate my reply as positive to credit the answer, thank you

Customer:

will the pfo be seen with an exray and can it be dealt with straight away

Dr S.A.Alam :

It needs transthoracic or esophgeal echo

Dr S.A.Alam :

which is a simple ultrasound test

Dr S.A.Alam :

yes it can be dealt easily without surgery but cardiologist has to prepare patient before this.

Customer:

can i not then ask the gp to do an ultra sound

Dr S.A.Alam :

simple ultrasound machine are not meant to see heart chambers

Dr S.A.Alam :

because probe is large and unable to see between ribs

Customer:

so will the cardiologist or the neurologolist have this equipment available to check or should i just go back to watford general where he was checked last time and ask for the pfo as they obviously were not looking for that

Dr S.A.Alam :

yes they have this equipment in their clinic.

Customer:

so as long as i make an immediate appointment with the apprpiriate doctor they will be able to identify whether it is a pfo and advise accordingly

Dr S.A.Alam :

yes it is correct.

Customer:

is there anything other than the pfo or asd that it could be

Dr S.A.Alam :

This can be a clot in the left heart due to any dysfunction which might be breaking away regularly

Dr S.A.Alam :

this will also be seen on echo

Dr S.A.Alam :

Do you have questions ?

Dr S.A.Alam :

I hope chat was helpful ?

Customer:

so either the cardiologist or neurologist could deal with the dysfunctional chamber if this is the case?

Dr S.A.Alam :

cardiologist will first evaluate his heart which is most likely cause and will also review the CT scans done previously

Dr S.A.Alam :

and then refer him to neurologist if needed.

Customer:

could this amount to bigger surgery?

Dr S.A.Alam :

normally with the lesions i have mentioned it is only a procedure like we do for stent implantation

Dr S.A.Alam :

regarding surgery it can only be told after his echo

Dr S.A.Alam :

I hope this answers your questions.

Dr S.A.Alam :

I have given you an extra 35 minutes on chat

Dr S.A.Alam :

which will now finish in 2 minutes.

Customer:

Thank you for this

Dr S.A.Alam :

You are welcome.

Dr S.A.Alam :

Do rate reply as positive to credit the answer, thank you.

Customer:

I am so glad we had this chat and hope this will be the end of his episodes

Dr S.A.Alam :

.

Dr S.A.Alam :

Yes

Dr S.A.Alam :

i am very hopeful that he will recover fully.

Customer:

Thank you again I do not have anymore questions

Dr S.A.Alam :

welcome....

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