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Old 27th Nov 2010, 17:31   #1 (permalink)
 
Join Date: Apr 2002
Location: Surrey, England
Posts: 679
Transient Ischemic Attack or 'mini-stroke'.

Hi Guys,

I wonder if anybody has relevant experience from which they might be able to advise me.

Two years ago, I had a weird kind of 'mini-stroke' one Saturday afternoon while I was out shopping. It happened like this. Over a period of perhaps five or ten minutes, when my glance fell upon the face of some other person, for just a split second it would look as though the other person either had no right eye, or alternatively had their right eye closed. On looking again, the person would now seem to have two eyes, both open. Other than that there were absolutely no other symptoms and I have experienced absolutely no stroke-like symptoms whatever during the subsequent two years.

At the time, I did not know what it was and so drove home in my car. I now know that I should have dialed 999 for an ambulance at once and gone to straight to hospital chop-chop.

As there was no GP's surgery on a Saturday and as the symptoms were brief and entirely optical I telephoned my optician. His view was that the occurrence may have been associated with migraine, but equally could perhaps be the result of a tiny stroke. I pointed out that I had never had migraine. He advised me to take half an aspirin and to inform my GP of the episode at the earliest opportunity, which I did.

My GP, however, failed to recognise the symptoms, which was understandable as they were most unusual. So it was another 22 months before the attack was recognised for what it was by an ophthalmologist I consulted.

For most of the last two years, my PPL has been expired, so I am not currently flying. However, I should like to return to flying before too long. At that point, I shall have to declare the attack to my AME. Does anybody please know what the CAA's policy is likely to be toward someone in my situation?

Regards,

Broomstick.
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Old 27th Nov 2010, 22:27   #2 (permalink)
 
Join Date: Sep 2007
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How does your ophthalmologist know for sure that it was a TIA?
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Old 28th Nov 2010, 09:17   #3 (permalink)
 
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Amaurosis Fugax perhaps?

Hi Anthony,

Obviously, I don't know 'how' the ophthalmologist knew it was a TIA. I would imagine it was a surmise based on experience.

One presumes that, as an ophthalmologist, he would be sufficiently expert on conditions affecting vision to be able to distinguish between purely optical conditions, that he could operate on, and the neurological things affecting vision, that he could not. Certainly, he said that my description of the attack was so specific that he felt safe in giving that diagnosis.

Looking in the (very brief) CAA guidance note on stroke, there is mention of a specific kind of TIA called Amaurosis Fugax, the general description of which seems very similar, but not the same as, what I experienced.

Why do you ask your question AnthonyGA. Do you have knowledge or experience in this area?

Broomstick.
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Old 29th Nov 2010, 13:14   #4 (permalink)
 
Join Date: Jul 2001
Location: UK
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Hi Broomstick Pilot

Just thought I'd post to say that both my mother and grandmother experienced something very similar, which turned out to be migraine.

During an attack, my grandmother noted that the entire one side of a persons face appeared missing when she looked at them. My mother also experienced the same.

As far as I'm aware, neither were diagnosed with TIA. Gran died some years ago, at the age of nearly 80 from a heart attack, and mum is still here (and I hope she continues to be for a long time).

I'd definately get a second opinion on what you have experienced, it may well be migraine, or some other sort of neuron electrical disturbance, as opposed to a TIA

Best of luck
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Old 29th Nov 2010, 20:45   #5 (permalink)
 
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Quote:
Why do you ask your question AnthonyGA. Do you have knowledge or experience in this area?
I'm not a doctor, but I do know that there are at least a dozen different causes for what you experienced, which (as you note) is called amaurosis fugax ("fleeting darkness"). It surprises me that an ophthalmologist would be able to confidently pronounce that it must have been a TIA, since the cause of this symptom can be difficult to pin down.

The reason why I question it is that a wrong diagnosis could lead to incorrect assumptions about the prognosis or required treatment (if any). Not only that, but declaring that you had a TIA could affect the status of your aviation medical. If it turned out to just be something benign, that would be a shame. It's a bit like doctors who blithely diagnose ADHD, and prescribe medication, not realizing that this diagnosis (which is notoriously difficult to establish unambiguously) could prevent a person from getting a pilot's license, even if he doesn't really have ADHD.

I'd get a second and third opinion, from cardiologists or neurologists or others more likely to be very specialized in the diagnosis and treatment of TIAs. You wouldn't go to a cardiologist to treat glaucoma, so best not to rely solely on an ophthalmologist to diagnose TIA. Especially given the potential health implications and the potential impact on your license. Doctors are only human, and each specialist has his own area of expertise, and may be a bit fuzzy on other areas (nobody's an expert in everything).
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Old 30th Nov 2010, 19:46   #6 (permalink)
 
Join Date: Apr 2000
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A few questions may help an unravelling of the diagnosis:

what is your age?
do you have any risk factors?
who made the diagnosis of TIA?
What, when, how long and what were the frequency of the symptoms (was it a one off).
What are your ideas, concerns, expectations.
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Old 30th Nov 2010, 20:16   #7 (permalink)

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Diagnosing a TIA on the basis of a single very transient visual disturbance 22 months ago seems bold, to say the least.

Mac
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Old 30th Nov 2010, 20:20   #8 (permalink)
 
Join Date: Aug 2007
Location: UK
Posts: 204
hi

hi im not a doctor but here's a possiblity, with a stroke you somthimes will get a numbness to the arm,or head. with a magraine, the visual distortion you get is when the part of the brain this is affected will swell, just like a head ache, whicah can be due too dehydration. the eye ball itself will expercience a small level of stress and you might get a temporary asigmatism, its just like when you rub your eye and you get little speckles of light, that is why it images look incomplete. after the magirate disapears so does the stress on the eye and the visual distortion disapears, and you ca be left with a headache. you can experience the full migrane or a visual aura, google it as well.
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Old 1st Dec 2010, 08:37   #9 (permalink)
 
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Location: Surrey, England
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Risk factors

Hi gingernut,

My age is 69,
My only risk factor is that I am just within the 'obese' weight category,
The diagnosis was made by an ophthalmologist who was definite that the attack should be investigated, by people in some appropriate specialism, even after more than a year since the attack took place.
The attack lasted about ten minutes, was a one-off and occurred two years ago. It was not accompanied by weakness or any other symptom.
What are my ideas, concerns, expectations? I want to get an as accurate a diagnosis as possible from the appropriate person. My concern obviously is whether the attack was indeed a TIA and if so the prospects of having a stroke at some future time, not to mention the possible implications for my PPL. Expectations? I have none until I have better information.

The reason for my original post was to find out how similar cases had been treated by the CAA and the medical establishment.

Regards,

Broomstick.
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Old 1st Dec 2010, 08:42   #10 (permalink)
 
Join Date: Apr 2002
Location: Surrey, England
Posts: 679
Thanks!

Guys,

I'd like to thank you all for your most useful and encouraging replies to my original post. It has all been most helpful.

Very many thanks!

BroomstickPilot.
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Old 1st Dec 2010, 13:32   #11 (permalink)
 
Join Date: Sep 2007
Location: Paris, France
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Quote:
What are my ideas, concerns, expectations? I want to get an as accurate a diagnosis as possible from the appropriate person.
One of the common characteristics of a TIA is that it may do no permanent damage, and it may not leave any trace of its occurrence. In fact, a TIA of this kind is harmless in itself; the only reason it causes concern is that some of the same things that cause TIAs can also cause more serious strokes that do some sort of permanent damage. Obviously, you want to prevent this latter type of stroke.

A corollary of this is that it's generally impossible to prove that a TIA has actually occurred. It doesn't do any permanent damage or leave any trace, so there's nothing to look for after the fact. Even if you could dissect the brain afterwards, you wouldn't find anything. All you can go on is the patient's history, symptoms, and any other conditions he might already have that raise risk (hypertension, diabetes, obesity, etc.).

Your ophthalmologist has probably had the same symptoms described to him many times by people who ultimately were determined to have had a TIA, or who had serious strokes later. However, he isn't specialized in the causes, prevention, and treatment of stroke, so apart from making a speculative observation, there's not much he can do (and his opinion could be taken with a grain of salt). If it were retinal detachment or glaucoma, he'd be the man to go to, but you need the right specialist for the right job.

Thus, you should look to specialists in cardiovascular disease and/or neurological conditions, who see this sort of thing every day, and who can try to isolate the cause(s) (if any) and come up with a plan of action to prevent any serious strokes in the future. They might also determine that it's not really a TIA at all, or that the cause was isolated or benign (or seriousóbut hopefully not). They know what tests to do and what to look for, even though the TIA itself may have disappeared into history now.

All of this is important for your health and your ticket. You don't want to have a "real" stroke, nor do you want to unnecessarily give up your license to fly. Get several specialist opinions. The more expert opinions you have, the better the results will be.
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Old 2nd Dec 2010, 13:23   #12 (permalink)
 
Join Date: Apr 2000
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Unfortunately TIA isn't easy to diagnose, in, fact the diagnosis is usually made from the story of the symptoms the patient gives.

At this stage, it'd be worth getting your risk factors for arterial disease assessed, and if need be, treated. (As it is for anyone your age).

If you wish to pursue the TIA route, you will need to chat to your GP who will then decide if you need further investigation- these may include blood tests, doppler tests and brain scans, via a specialist.

Each GP will have a slightly different threshold for referring, which may be influenced by your ideas, concerns and expectations.

Confirmation of TIA will be dimly viewed by aviation medical people.
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