Is this the end?
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Rory, you seem to be knowledgeable (and I'm very grateful indeed for the time that you and others put-in to replying) but I'm surprised that you say this was a TIA. The doc called it a "small stroke" and from what I can find it is also called a Lacunar stroke ... in my case a little knowledge is a dangerous thing so I would be grateful if you could explain a little more, or give an authoritative link for further research.
Lacunar refers mainly to the location of the stroke. I don't think it is applied to TIAs, since lacunar strokes involve a significant obstruction of blood flow, whereas TIAs are tiny and temporary.
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The whole field of cerebral ischemia is classified into a number off different stages, including TIA, PRIND, PS and CS. The severity is different, as are clinical symptoms.
The TIA or trasitoric ischemic attack is classified with symptoms that fully recover within 24 hours. That is what you have mentioned.
Next level would be a PRIND or prolonged ischemic neurologic deficit. That lasts longer than 24 hours, but symptoms return to full normal.
The progerssive stroke (PS) has increasing symptoms over a period of 4 weeks, symptoms are not fully reversible.
And the completed stroke (CS) has chronic neurologic deficits.
So from that definition you did not have a stroke. Nevertheless, if looking at MR images, you will see a focal loss of brain tissue (in your case half the size of a peanut), and radiologists usually will describe that as 'compatible with a stroke' or as a 'lacunar stroke / infarct', which is a bit misleading, as the definition of a stroke includes a permanent loss of neurologic function. I think, this is, where this disagreement of diagnosis originates from.
Sending somebody home from the ER with a stroke I would consider as a mistreatment, as with a stroke you have a significant area of the brain with inadequate oxygen supply. Depending on the duration, one would need to do everything possible to make this region as small as possible. But with a TIA, this is different, as the neurologic deficit is short lived. Protection of further events and search for the culprit is the adequate way to go.
From my perspective, calling it a stroke will not have positive effects on your ability to regain your medical, as physicians might associate something different with a stroke than with a TIA. That is why I was so clear in pointing out that it was not a stroke.
The good thing with a TIA is, that it was so small and the amount of brain tissue involved was small enougt, that plasticicity of the brain was capable of rerouting the nerve-cell function of the area, which got lost to other cells, and function is 100% back. So no lasting residuals. Therefore, the TIA really just is the wake up call, and it is never too late.
I have to add one information, I forgot in my recent comment. The percentages for stroke risk over time after an TIA are for untreated patients. Treatment has shown to be effective to reduce these numbers.
To your question with PFO. I am not absolutely sure what you mean, but if it is a patent foramen ovale, the easiest test would be a contrast enhanced echocardiography. With echo you could also look for thrombus in the atrium and for the aortic root, but for the latter there could be the need for a transesophageal probe position (which sounds worse than it actually is).
Alternatively, you could go for cardiac MRI to look for the left atrium, an assessment of the foramen ovale as well as the aortic root. Unfortunately, you need a high end MR scanner and somebody who is trained in cardiac MRI.
The TIA or trasitoric ischemic attack is classified with symptoms that fully recover within 24 hours. That is what you have mentioned.
Next level would be a PRIND or prolonged ischemic neurologic deficit. That lasts longer than 24 hours, but symptoms return to full normal.
The progerssive stroke (PS) has increasing symptoms over a period of 4 weeks, symptoms are not fully reversible.
And the completed stroke (CS) has chronic neurologic deficits.
So from that definition you did not have a stroke. Nevertheless, if looking at MR images, you will see a focal loss of brain tissue (in your case half the size of a peanut), and radiologists usually will describe that as 'compatible with a stroke' or as a 'lacunar stroke / infarct', which is a bit misleading, as the definition of a stroke includes a permanent loss of neurologic function. I think, this is, where this disagreement of diagnosis originates from.
Sending somebody home from the ER with a stroke I would consider as a mistreatment, as with a stroke you have a significant area of the brain with inadequate oxygen supply. Depending on the duration, one would need to do everything possible to make this region as small as possible. But with a TIA, this is different, as the neurologic deficit is short lived. Protection of further events and search for the culprit is the adequate way to go.
From my perspective, calling it a stroke will not have positive effects on your ability to regain your medical, as physicians might associate something different with a stroke than with a TIA. That is why I was so clear in pointing out that it was not a stroke.
The good thing with a TIA is, that it was so small and the amount of brain tissue involved was small enougt, that plasticicity of the brain was capable of rerouting the nerve-cell function of the area, which got lost to other cells, and function is 100% back. So no lasting residuals. Therefore, the TIA really just is the wake up call, and it is never too late.
I have to add one information, I forgot in my recent comment. The percentages for stroke risk over time after an TIA are for untreated patients. Treatment has shown to be effective to reduce these numbers.
To your question with PFO. I am not absolutely sure what you mean, but if it is a patent foramen ovale, the easiest test would be a contrast enhanced echocardiography. With echo you could also look for thrombus in the atrium and for the aortic root, but for the latter there could be the need for a transesophageal probe position (which sounds worse than it actually is).
Alternatively, you could go for cardiac MRI to look for the left atrium, an assessment of the foramen ovale as well as the aortic root. Unfortunately, you need a high end MR scanner and somebody who is trained in cardiac MRI.
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Hi everyone, I hope you don't mind me joining in on this thread as I have suddenly found myself in almost the same situation as rick... my life has been turned upside down and I am thinking it may well be all over flying wise but I am focusing my time on research.
My incident happened a few days ago - slight reduced movement in hand, blurred vision, light headache - admitted and underwent CT, MRI, MRA - told the MRI/A had shown an area of small infarct therefore they are assuming stroke.
I am trying to gather as much information to argue for a different diagnosis as I have regained all motor movement.
My current thoughts are to firstly ask for a 2nd opinion / scan on the infarct taking into account technical error, partial volume extract, misinterpretation etc
Secondly as I do not fit the profile - low bp, normal chol, young age, not obese, regular exerciser, ok diet, etc I am very keen to find a causal factor to help build my case.
I found Rory's posts VERY interesting but a little digging on the net suggests the term PRIND is no longer used. Indeed the medical definition of stroke I keep finding only suggests... "A stroke is the sudden death of brain cells in a localized area due to inadequate blood flow" ... and not mentioning a permanent loss of function or otherwise.
My concern therefore is that the stroke definition is very much a catch all.
My incident happened a few days ago - slight reduced movement in hand, blurred vision, light headache - admitted and underwent CT, MRI, MRA - told the MRI/A had shown an area of small infarct therefore they are assuming stroke.
I am trying to gather as much information to argue for a different diagnosis as I have regained all motor movement.
My current thoughts are to firstly ask for a 2nd opinion / scan on the infarct taking into account technical error, partial volume extract, misinterpretation etc
Secondly as I do not fit the profile - low bp, normal chol, young age, not obese, regular exerciser, ok diet, etc I am very keen to find a causal factor to help build my case.
I found Rory's posts VERY interesting but a little digging on the net suggests the term PRIND is no longer used. Indeed the medical definition of stroke I keep finding only suggests... "A stroke is the sudden death of brain cells in a localized area due to inadequate blood flow" ... and not mentioning a permanent loss of function or otherwise.
My concern therefore is that the stroke definition is very much a catch all.
Psychophysiological entity
I'm a retired pilot, but I'm curious about the conclusions.
Can you gain any information as to what they mean by small? Perhaps comparing it with a pea, marble, etc.
Did they explain the reason for the visual disturbance, and was it simply blurred, or did it have any patterns?
Was the headache global, or concentrated in one area?
small infarct
Did they explain the reason for the visual disturbance, and was it simply blurred, or did it have any patterns?
Was the headache global, or concentrated in one area?
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SWO: The terminology of cerebral ischemia is currently under discussion and partly changing, nevertheless, I do get the idea from looking into more recent statements, that this isn't final yet. But you are right, the PRIND isn't that much used recently, nevertheless if you search for that in medline, you will still get current citations.
At the end, it is somehow semantic. The underlying pathophysiology of whatever you call it, is a lack of oxygen supply, most commonly by occlusion of a vessel of varying diameter, or, less common, by hemorrhage. The latter is not the case for you as well as for Rick, because MR would look differently.
The current discussion for always calling it a stroke, I have the feeling, basically results from an identical pharmaceutical treatment for both, except if any type of reopening procedure would be used, what one would only do in a stroke. In a TIA, the affected area must be small enough to allow neurologic remodeling, while in the full blown stroke the area affected in general is larger, not allowing a fast and full recovery to normal. For both there is an increased risk of a second or full scale stroke, thus pharmacotherapy is aimed at preventing this.
Now, if your goal is to improve the outcome, which best is achieved by treating all patients, independently of the severity of their clinical findings with protective pharmacotherapy, than it seems logical to call all clincal findings a stroke. In former times, when CT and MRI wasn't that widely available, you wouldn't be able to see the underlying destruction, thus the differentiation of the stages was done on a clinical basis. In my personal view, treatment is wider than just pharmacotherapy, and patients with a stroke generally would also need physical help in regaining as much brainfunction as possible. That is not needed in TIA.
The term TIA is most certainly not (yet) obsolete, and many doctors will interpret a diagnosis 'TIA' differently than 'stroke', thus it is in my view a legitimate offer in the hope to regain your medicals. It doesn't guarantee, but it surely doesn't hamper the process.
To your further questions: usually you wouldn't need a second scan, just a second reading will most of the time suffice. Interpretation of typical findings in brain MRI is not that difficult, nevertheless, in the individual case it might be chalenging.
If you have no risk factors, one thing you could look for would be Lp(a), a special lipoprotein which seems to be involved in quite some patients with atherosclerotic disease and no other risk factors.
Are you a diver?
At the end, it is somehow semantic. The underlying pathophysiology of whatever you call it, is a lack of oxygen supply, most commonly by occlusion of a vessel of varying diameter, or, less common, by hemorrhage. The latter is not the case for you as well as for Rick, because MR would look differently.
The current discussion for always calling it a stroke, I have the feeling, basically results from an identical pharmaceutical treatment for both, except if any type of reopening procedure would be used, what one would only do in a stroke. In a TIA, the affected area must be small enough to allow neurologic remodeling, while in the full blown stroke the area affected in general is larger, not allowing a fast and full recovery to normal. For both there is an increased risk of a second or full scale stroke, thus pharmacotherapy is aimed at preventing this.
Now, if your goal is to improve the outcome, which best is achieved by treating all patients, independently of the severity of their clinical findings with protective pharmacotherapy, than it seems logical to call all clincal findings a stroke. In former times, when CT and MRI wasn't that widely available, you wouldn't be able to see the underlying destruction, thus the differentiation of the stages was done on a clinical basis. In my personal view, treatment is wider than just pharmacotherapy, and patients with a stroke generally would also need physical help in regaining as much brainfunction as possible. That is not needed in TIA.
The term TIA is most certainly not (yet) obsolete, and many doctors will interpret a diagnosis 'TIA' differently than 'stroke', thus it is in my view a legitimate offer in the hope to regain your medicals. It doesn't guarantee, but it surely doesn't hamper the process.
To your further questions: usually you wouldn't need a second scan, just a second reading will most of the time suffice. Interpretation of typical findings in brain MRI is not that difficult, nevertheless, in the individual case it might be chalenging.
If you have no risk factors, one thing you could look for would be Lp(a), a special lipoprotein which seems to be involved in quite some patients with atherosclerotic disease and no other risk factors.
Are you a diver?
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I am trying to gather as much information to argue for a different diagnosis as I have regained all motor movement.
My current thoughts are to firstly ask for a 2nd opinion / scan on the infarct taking into account technical error, partial volume extract, misinterpretation etc
Secondly as I do not fit the profile - low bp, normal chol, young age, not obese, regular exerciser, ok diet, etc I am very keen to find a causal factor to help build my case.
My current thoughts are to firstly ask for a 2nd opinion / scan on the infarct taking into account technical error, partial volume extract, misinterpretation etc
Secondly as I do not fit the profile - low bp, normal chol, young age, not obese, regular exerciser, ok diet, etc I am very keen to find a causal factor to help build my case.
Psychophysiological entity
Again speaking as a layman, I think the thing to realize is the physical scale on which these things can occur. Some of the relevant blood vessel diameters can be measured in microns - just big enough for platelets to flow. What is incredible, is that these problems don't happen more frequently.
One-offs can occur, but there is the issue of repeat problems with larger vessels, so yes, I would want the best prognosis/guess of the future dangers available. Trouble is, it's doubtful anyone would want to stick their neck out on a specific case.
One-offs can occur, but there is the issue of repeat problems with larger vessels, so yes, I would want the best prognosis/guess of the future dangers available. Trouble is, it's doubtful anyone would want to stick their neck out on a specific case.
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PFO?
Rick
This could have nothing whatever to do with what caused your episode, but it might be of interest, so it can't do any harm to tell you that my wife had a very similar "funny turn" last April which also turned out to be a minor stroke.
The medical profession put her through a battery of tests: blood tests, cholesterol, MRIs etc etc in an effort to explain why she'd had a stroke at a comparatively young age (late 40's). Apart from mildly elevated cholesterol, there was nothing out of the ordinary until they gave her a "bubble test" which revealed that she had a PFO (Patent Foramen Ovale) or hole in the wall between the upper chambers (atria) of her heart. It seems that there is a growing body of evidence linking PFO with what they call "cryptogenic" stroke, i.e. one whose cause is not otherwise obvious. Seemingly (and I apologise to those with greater medical knowledge if this explanation isn't 100%, I'm just trying to keep it simple) blood from one atrium is pumped to the lungs for oxygenation, and some tiny clots which may be present get lodged harmlessly in the lungs which thereby act as a filter. Thereafter it returns to the heart where the other atrium sends it off, duly oxygenated and filtered, around the rest of the body. With a PFO the unfiltered blood can get through to the "rest of the body" atrium and cause problems elsewhere, including the brain. There is also an as-yet completely unproven but very interesting-looking correlation between PFO and migraine, and an intriguing number of migraineurs who have had PFO closure operations have experienced a significant reduction in frequency and intensity of migraines, if not a complete cessation - with one caveat, of which more in a mo....
My wife had her PFO examined in greater detail with the previously-mentioned Trans Oesophageal Echocardiogram (which involves swallowing a camera) and was assessed as suitable for having her PFO closed. This was done in November with a keyhole procedure involving a pair of what I can best describe as something like a pair of small cocktail umbrellas (albeit made of a nickel-titanium alloy with a PTFE membrane) sent in via a tube inserted in the femoral artery.
Although her PFO was now closed, she seemed to have an increase in the frequency of her migraines (from which she's suffered all her life), which was disappointing because she'd had high hopes of the closure op helping with these. We then began to investigate the possibility that she might be having a reaction to the nickel content of the closure device, (as she's always had a reaction to the nickel content of cheap jewellery - although lots of women don't get on with cheap jewellery, for many other reasons!) With some research online, it seemed that using Clopidogrel and not Persantin as the anti-platelet medication might very quickly put a stop to that; she had been put on Persantin (dipyridamole) after the stroke, and the change to Clopidogrel seems (touch wood) to have done the trick - no more migraines since. Once the body's tissue has completely grown over the PFO closure device (six months or so post-op) she may be able to come off the Clopidogrel.
Couple of links which were helpful in my wife's case and which might be of interest:
PFO closure and recovery information - HealingWell.com Forum
YouTube - PFO Closure Device
GORE® HELEX Septal Occluder Video
Adverse Events Associated With Nickel Allergy in Patients Undergoing Percutaneous Atrial Septal Defect or Patent Foramen Ovale Closure -- Wertman et al. 47 (6): 1226 -- Journal of the American College of Cardiology
As I say, all this could be completely irrelevant to you, but maybe not.
Very, very best of luck to you.
JJ
This could have nothing whatever to do with what caused your episode, but it might be of interest, so it can't do any harm to tell you that my wife had a very similar "funny turn" last April which also turned out to be a minor stroke.
The medical profession put her through a battery of tests: blood tests, cholesterol, MRIs etc etc in an effort to explain why she'd had a stroke at a comparatively young age (late 40's). Apart from mildly elevated cholesterol, there was nothing out of the ordinary until they gave her a "bubble test" which revealed that she had a PFO (Patent Foramen Ovale) or hole in the wall between the upper chambers (atria) of her heart. It seems that there is a growing body of evidence linking PFO with what they call "cryptogenic" stroke, i.e. one whose cause is not otherwise obvious. Seemingly (and I apologise to those with greater medical knowledge if this explanation isn't 100%, I'm just trying to keep it simple) blood from one atrium is pumped to the lungs for oxygenation, and some tiny clots which may be present get lodged harmlessly in the lungs which thereby act as a filter. Thereafter it returns to the heart where the other atrium sends it off, duly oxygenated and filtered, around the rest of the body. With a PFO the unfiltered blood can get through to the "rest of the body" atrium and cause problems elsewhere, including the brain. There is also an as-yet completely unproven but very interesting-looking correlation between PFO and migraine, and an intriguing number of migraineurs who have had PFO closure operations have experienced a significant reduction in frequency and intensity of migraines, if not a complete cessation - with one caveat, of which more in a mo....
My wife had her PFO examined in greater detail with the previously-mentioned Trans Oesophageal Echocardiogram (which involves swallowing a camera) and was assessed as suitable for having her PFO closed. This was done in November with a keyhole procedure involving a pair of what I can best describe as something like a pair of small cocktail umbrellas (albeit made of a nickel-titanium alloy with a PTFE membrane) sent in via a tube inserted in the femoral artery.
Although her PFO was now closed, she seemed to have an increase in the frequency of her migraines (from which she's suffered all her life), which was disappointing because she'd had high hopes of the closure op helping with these. We then began to investigate the possibility that she might be having a reaction to the nickel content of the closure device, (as she's always had a reaction to the nickel content of cheap jewellery - although lots of women don't get on with cheap jewellery, for many other reasons!) With some research online, it seemed that using Clopidogrel and not Persantin as the anti-platelet medication might very quickly put a stop to that; she had been put on Persantin (dipyridamole) after the stroke, and the change to Clopidogrel seems (touch wood) to have done the trick - no more migraines since. Once the body's tissue has completely grown over the PFO closure device (six months or so post-op) she may be able to come off the Clopidogrel.
Couple of links which were helpful in my wife's case and which might be of interest:
PFO closure and recovery information - HealingWell.com Forum
YouTube - PFO Closure Device
GORE® HELEX Septal Occluder Video
Adverse Events Associated With Nickel Allergy in Patients Undergoing Percutaneous Atrial Septal Defect or Patent Foramen Ovale Closure -- Wertman et al. 47 (6): 1226 -- Journal of the American College of Cardiology
As I say, all this could be completely irrelevant to you, but maybe not.
Very, very best of luck to you.
JJ
Last edited by Jumbo Jockey; 23rd Feb 2011 at 21:01. Reason: clarification
Psychophysiological entity
JJ a very informative post.
I'm pretty convinced about the link to classical migraine, as I've mentioned on this forum over the years. Strangely, two friends with lifelong migraine have been diagnosed with that leakage in resent years.
The release by the heart of a hormone was mentioned.
One thing I have not felt appropriate to mention was something I have read in the last few years. I can't remember where I read it, but I wouldn't have given any credence to a totally unqualified source, though it might have been a migraine-specific forum, and thus open to 'interpretation.'
"In the US, more people die of migraine-related stroke than from gunshot wounds."
It does of course include the elderly, but belies the belief that migraine is a totally benign malaise.
I have long believed each episode causes small amounts of damage - perhaps minute, but to me, this spells out the importance of ridding the patient of the triggers for migraine, rather than treating the symptoms.
I'm pretty convinced about the link to classical migraine, as I've mentioned on this forum over the years. Strangely, two friends with lifelong migraine have been diagnosed with that leakage in resent years.
The release by the heart of a hormone was mentioned.
One thing I have not felt appropriate to mention was something I have read in the last few years. I can't remember where I read it, but I wouldn't have given any credence to a totally unqualified source, though it might have been a migraine-specific forum, and thus open to 'interpretation.'
"In the US, more people die of migraine-related stroke than from gunshot wounds."
It does of course include the elderly, but belies the belief that migraine is a totally benign malaise.
I have long believed each episode causes small amounts of damage - perhaps minute, but to me, this spells out the importance of ridding the patient of the triggers for migraine, rather than treating the symptoms.
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I've been following this thread withn increasing concern... Before I started my PPL training I asked if migraine would prevent me passing my medical. I was assured that it wouldn't be a problem - and it wasn't. Some 12 years on, I'm still flying and still get the occasional migraine, nothing like as bad as in earlier years, and of course I wouldn't fly if one occured before I departed. So far I have never had an attack whilst flying.
I recently stopped (on the doctors instruction) my 2.5mg bendro. tablet for mild hypertension. Around the same time it was my turn as President of the local Rotary Club. Soon after, the migraines returned, as often as twice a week. My BP had gone up considerably, so I went back on the tablets, and the problem went away, with BP back down to a more acceptable 127/70.
I found this link:- Migraines: Myth Vs. Reality which confirmed the link between strokes & migraine as metioned by LR.
I hope that you sort this out, AnthonyGA and that you can carry on doing what we all love to do. RF
I recently stopped (on the doctors instruction) my 2.5mg bendro. tablet for mild hypertension. Around the same time it was my turn as President of the local Rotary Club. Soon after, the migraines returned, as often as twice a week. My BP had gone up considerably, so I went back on the tablets, and the problem went away, with BP back down to a more acceptable 127/70.
I found this link:- Migraines: Myth Vs. Reality which confirmed the link between strokes & migraine as metioned by LR.
I hope that you sort this out, AnthonyGA and that you can carry on doing what we all love to do. RF
Psychophysiological entity
Since there might be a link with the OP's original post, I'll just make a brief comment.
I read the above link through very carefully, and they do seem to seek information from good establishments, but I'm not convinced they're on the right track with the reason for the dilation.
For a long time I've thought the dilation might be the brain's emergency response to over-clamping or restriction caused by other causes. So many factors make sense looking at it this way around.
This doesn't mean any of the link's reported notions are wrong per se, though I'm personally all but convinced there is some psychological factor. I think the combination of triggers is valid, and cheese and chocolate are high on the suspect list. They do seem to need a brain that's ready sprung to react.
Anyway, this is veering off the original topic, and as I said I was reluctant to mention the connection for fear of the concerns it may cause, but being armed with information is probably best.
I read the above link through very carefully, and they do seem to seek information from good establishments, but I'm not convinced they're on the right track with the reason for the dilation.
For a long time I've thought the dilation might be the brain's emergency response to over-clamping or restriction caused by other causes. So many factors make sense looking at it this way around.
This doesn't mean any of the link's reported notions are wrong per se, though I'm personally all but convinced there is some psychological factor. I think the combination of triggers is valid, and cheese and chocolate are high on the suspect list. They do seem to need a brain that's ready sprung to react.
Anyway, this is veering off the original topic, and as I said I was reluctant to mention the connection for fear of the concerns it may cause, but being armed with information is probably best.
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Friend of mine had something similar a few years ago and was in hospital for a while, found out that he had been cycling around Kielder reservoir near Newcastle and some bug had stuck in him causing something similar
Good luck.
Good luck.
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Well, as you asked 
.
There's been no change in my condition. A blood test (which seemed to need a whole armful of blood!) to check for clotting tendency came back all OK. I'm currently waiting for a cardiac echo scan appointment.
I was initially prescribed daily 75mg Aspirin but this has been changed to 75mg Clopidogrel - when I asked how long I'd be on this for the rather brusk answer was "for life", which as someone who tries to avoid taking potions came as a bit of a shock.
The CAA have asked me to get my consultant to send a detailed report - hopefully this will be with them soon and then I'll have an outlook.
I'm very grateful for all the helpful comments, and for the PMs.
Rick
. There's been no change in my condition. A blood test (which seemed to need a whole armful of blood!) to check for clotting tendency came back all OK. I'm currently waiting for a cardiac echo scan appointment.
I was initially prescribed daily 75mg Aspirin but this has been changed to 75mg Clopidogrel - when I asked how long I'd be on this for the rather brusk answer was "for life", which as someone who tries to avoid taking potions came as a bit of a shock.
The CAA have asked me to get my consultant to send a detailed report - hopefully this will be with them soon and then I'll have an outlook.
I'm very grateful for all the helpful comments, and for the PMs.
Rick
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Hey rick hope your feeling better soon. Thought I would update too as our cases are so similar to each other.
Since my last post in Jan my life has changed dramatically. I lost my flying job as a result of the medical suspension, lost my home (as it came with the job), have moved in with my parents again (highly humiliating but thankful) and have a dwindling supply of cash, hope and patience. I can't even get a job as a baggage handler as I'm "over qualified"
Medically wise the reason for my lack of comments was due to a series of diagnostic options and tests being undertaken. Initially I was told I had most likely suffered a carotid artery dissection of the neck which had led to the stroke... this was a very promising development as the outcome was potentially good and recurrence rates low. A CT angiogram with contrast was arranged to radiologically confirm this and to my dismay came back all clear - I had not had a dissection.
Cue MORE tests, more waiting, more uncertainty... next up it's 24hr ECG and bubble echo to look at the possibility of PFO (as mentioned earlier by another poster) If these tests come back negative then they say I will be diagnosed with "cryptogenic stroke" - i.e. unknown cause!
As you can imagine the possibly cause being unknown is a disaster... I can't see the CAA liking that one bit. I'm so exasperated - I have luckily made a full recovery and have passed all neurological tests 100% but feel like my flying career is slipping away. I wouldn't mind perhaps if I was 30yrs in already but I have only had my licence for 3 years after 5 years of saving, working and living in caravans to make it happen
Since my last post in Jan my life has changed dramatically. I lost my flying job as a result of the medical suspension, lost my home (as it came with the job), have moved in with my parents again (highly humiliating but thankful) and have a dwindling supply of cash, hope and patience. I can't even get a job as a baggage handler as I'm "over qualified"
Medically wise the reason for my lack of comments was due to a series of diagnostic options and tests being undertaken. Initially I was told I had most likely suffered a carotid artery dissection of the neck which had led to the stroke... this was a very promising development as the outcome was potentially good and recurrence rates low. A CT angiogram with contrast was arranged to radiologically confirm this and to my dismay came back all clear - I had not had a dissection.
Cue MORE tests, more waiting, more uncertainty... next up it's 24hr ECG and bubble echo to look at the possibility of PFO (as mentioned earlier by another poster) If these tests come back negative then they say I will be diagnosed with "cryptogenic stroke" - i.e. unknown cause!
As you can imagine the possibly cause being unknown is a disaster... I can't see the CAA liking that one bit. I'm so exasperated - I have luckily made a full recovery and have passed all neurological tests 100% but feel like my flying career is slipping away. I wouldn't mind perhaps if I was 30yrs in already but I have only had my licence for 3 years after 5 years of saving, working and living in caravans to make it happen
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D-Dimer blood test high
I recently asked my GP for more details about the blood test and it turns-out that it was not "all OK" as previously reported - the D-Dimer result was high. The GP did not think it was a very meaningful test and doesn't intend to do any further investigation as a result because he thought the original embolism would have caused the elevated level. Is this valid when there were nearly 7 weeks between the "event" and the test?
I'm booked-in for an echocardiogram in a few weeks, to check for a PFO. If that comes-back negative I guess this whole thing will go down as an act of god.
Sorry to hear the news from SWO and others.
I've actually been rather surprised by the number of people who've contacted me to say they've had similar symptoms - this seems far more common than I realised.
I started-out by thinking that it was a real pain that this had happened to me, and how do I get back to where I was before. But having now seen a number of people who have had full-blown strokes, and realised how common this is, my attitude is now how relieved I am that it wasn't worse and taking action to reduce the risk of something worse happening.
Rick
I'm booked-in for an echocardiogram in a few weeks, to check for a PFO. If that comes-back negative I guess this whole thing will go down as an act of god.
Sorry to hear the news from SWO and others.
I've actually been rather surprised by the number of people who've contacted me to say they've had similar symptoms - this seems far more common than I realised.
I started-out by thinking that it was a real pain that this had happened to me, and how do I get back to where I was before. But having now seen a number of people who have had full-blown strokes, and realised how common this is, my attitude is now how relieved I am that it wasn't worse and taking action to reduce the risk of something worse happening.
Rick
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Small update
Having done some research it eeems that the D-Dimer test is more valuable as a diagnostic tool when the results are negative, rather than positive, so maybe that result goes into the "so what" category.
Some interesting new expert advice has arrived from the sidelines and it is that somebody relatively young should be pushing for few specific tests (a transoesephgeal echocardiagram (rather than the transthoracic scan that I have booked, a 24 hour ECG, and an Aortic scan) so I can foresee some interesting discussions ahead.
Rick
Some interesting new expert advice has arrived from the sidelines and it is that somebody relatively young should be pushing for few specific tests (a transoesephgeal echocardiagram (rather than the transthoracic scan that I have booked, a 24 hour ECG, and an Aortic scan) so I can foresee some interesting discussions ahead.
Rick
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No PFO
A brief update for anyone who's still interested: a saline bubble echocardiogram has apparently shown that I have a healthy heart and do not have a PFO. The CAA's judgement is awaited.
Rick
Rick
Psychophysiological entity
Yes, I'm sure many of us are still interested - keep the posts coming.
All the best. LR
All the best. LR
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Bald Rick,
New on here and just picked up this thread - In April 2009 I was a JAR PPL when I suffered a TIA whilst on the telephone at my place of work in Swansea. I had undertaken a Class 2 medical just a month or so before which was ok apart from raised blood pressure for which had been receiving medication for many years.
I totally lost my speech (very frightening) but I knew straight away it was a stroke. Fortunately I was taken very quickly to Morriston Hospital which was the only hospital in Wales trialling a new clot busting drug. I was given a MRI scan and assessed as being suitable to be given the drug for which I had to sign a disclaimer as it has risks like causing a further stroke or heart attack within 24 hours post administration.
The drug has to be administered within 2 hours and the Consultant who was awaiting my arrival in A & E advised me to have it administered as I was relatively young ( 60 ) The Consultant later told me that I was the fifth person to have it administered with varying results - he did not tell me what these were! I was hospitalised for 6 days.
Over a period of 24 hours my speech returned but slower than before and slightly slurred but this improved over the following weeks plus speech Therapy concentrating on aircraft jargon / call signs etc with my NHS Therapist!
My AME told me I would never fly again ( I own an Annex 11 Taylorcraft ) and the CAA pulled my medical but were very helpful encouraging me to go down the NPPL route. The DVLA also pulled my driving licence for six months.
After several months I resumed flying again with an Instructor and I suppose in all undertook 16 hours or so joint flying until I was totally satisfied that I remained competent and also wished to continue flying which I did desperately! My problem as such was slightly slow / slurred speech which spooked me in controlled airspace.
After 6 months my lady Doctor signed me off for a class 1 NPPL medical ( solo flying or with a safety pilot ) and I flew mainly solo locally around West Wales etc. My confidence increased with the radio work thanks to the ATC at Swansea and also Cardiff were helpful as on occasions they had to be patient with my read back of clearances and must have been aware I had a problem of sorts!
My Doctor told me that if I remained medically incident free for a further 6 months and passed a treadmill test that she would sign me off for the class 2 NPPL medical so that I could take non Pilot passengers which she did. My Partner had always enjoyed flying and wished to continue to do so with me as did certain members of my family and friends.
I now fly mainly locally in the West Wales and South West area and I am told that my speech is as good or better than some foreign commercial Pilots!
If I want to fly to areas outside my comfort zone in terms of radio work I take a Pilot friend to relieve me if needs be ( so far this has never occurred ) I think it helps flying a slightly unusual aircraft as ATC seem to spend more time wondering what you are as opposed to what you are saying!
My advice to anyone in a similar position would be never to give up the wish to fly but be realistic about what you want to achieve but always remember that there is no such thing as a mini / slight / small stroke as all are serious medical interventions.
Likewise don't waste time and energy trying to convince the " Authorities " that you havn't suffered a stroke or TIA as if you have displayed the symptoms you most probably have and they will air on the side of caution! In any case you can't change Doctors / Consultants reports which they will ask for.
Don't be complacent about your health and think a JAR Medical with ECG's is a safety back up - it certainly wasn't for me! as it is just a snap shot of you on the day!
Above else remain positive as if you are even considering flying again you have been very lucky to get away lightly on this occasion!
New on here and just picked up this thread - In April 2009 I was a JAR PPL when I suffered a TIA whilst on the telephone at my place of work in Swansea. I had undertaken a Class 2 medical just a month or so before which was ok apart from raised blood pressure for which had been receiving medication for many years.
I totally lost my speech (very frightening) but I knew straight away it was a stroke. Fortunately I was taken very quickly to Morriston Hospital which was the only hospital in Wales trialling a new clot busting drug. I was given a MRI scan and assessed as being suitable to be given the drug for which I had to sign a disclaimer as it has risks like causing a further stroke or heart attack within 24 hours post administration.
The drug has to be administered within 2 hours and the Consultant who was awaiting my arrival in A & E advised me to have it administered as I was relatively young ( 60 ) The Consultant later told me that I was the fifth person to have it administered with varying results - he did not tell me what these were! I was hospitalised for 6 days.
Over a period of 24 hours my speech returned but slower than before and slightly slurred but this improved over the following weeks plus speech Therapy concentrating on aircraft jargon / call signs etc with my NHS Therapist!
My AME told me I would never fly again ( I own an Annex 11 Taylorcraft ) and the CAA pulled my medical but were very helpful encouraging me to go down the NPPL route. The DVLA also pulled my driving licence for six months.
After several months I resumed flying again with an Instructor and I suppose in all undertook 16 hours or so joint flying until I was totally satisfied that I remained competent and also wished to continue flying which I did desperately! My problem as such was slightly slow / slurred speech which spooked me in controlled airspace.
After 6 months my lady Doctor signed me off for a class 1 NPPL medical ( solo flying or with a safety pilot ) and I flew mainly solo locally around West Wales etc. My confidence increased with the radio work thanks to the ATC at Swansea and also Cardiff were helpful as on occasions they had to be patient with my read back of clearances and must have been aware I had a problem of sorts!
My Doctor told me that if I remained medically incident free for a further 6 months and passed a treadmill test that she would sign me off for the class 2 NPPL medical so that I could take non Pilot passengers which she did. My Partner had always enjoyed flying and wished to continue to do so with me as did certain members of my family and friends.
I now fly mainly locally in the West Wales and South West area and I am told that my speech is as good or better than some foreign commercial Pilots!
If I want to fly to areas outside my comfort zone in terms of radio work I take a Pilot friend to relieve me if needs be ( so far this has never occurred ) I think it helps flying a slightly unusual aircraft as ATC seem to spend more time wondering what you are as opposed to what you are saying!
My advice to anyone in a similar position would be never to give up the wish to fly but be realistic about what you want to achieve but always remember that there is no such thing as a mini / slight / small stroke as all are serious medical interventions.
Likewise don't waste time and energy trying to convince the " Authorities " that you havn't suffered a stroke or TIA as if you have displayed the symptoms you most probably have and they will air on the side of caution! In any case you can't change Doctors / Consultants reports which they will ask for.
Don't be complacent about your health and think a JAR Medical with ECG's is a safety back up - it certainly wasn't for me! as it is just a snap shot of you on the day!
Above else remain positive as if you are even considering flying again you have been very lucky to get away lightly on this occasion!