Is this the end?
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A "funny spell" - is this the end?
Yesterday:
It seems not quite like a stroke/TIA and not quite a severe migraine.
Obviously I'm out of action for a couple of weeks, but is it going to be time to end 30 years in aviation?
What's the verdict of the jury?
B Rick
- around midday a sudden almost total numbness of left arm, left side of head (including L tongue, lips and teeth) & body (and partial in L leg). No loss of movement, strength, balance, vision, hearing, or taste; no "dropping" of features, no psychological change - continued with normal life.
- over a couple of hours most of the feeling returned but accompanied by pins and needles (like when recovering from dental local anaesthetic).
- Saw GP about 4 hours after initial event, no fault found but sent to hospital. Hospital chap prescribed high dose aspirin and Persantin "in case" and sent me home - advised no driving (and by inference no flying) for 28 days. Warned that Persantin can cause headaches - he was right!
- MRI on head at early o'clock and doppler scan of arteries in neck ... all normal. Bloods taken.
- Currently some loss of touch sensation and tingling remain on: left side of head (L upper teeth, L tongue, & L lips feel odd), L pinkie, L thumb
It seems not quite like a stroke/TIA and not quite a severe migraine.
Obviously I'm out of action for a couple of weeks, but is it going to be time to end 30 years in aviation?
What's the verdict of the jury?
B Rick
Psychophysiological entity
Hi, sorry to read about your episode.
There's so little the layman can say, and you seem to be fast-tracking the medical system, and that's good. I'm a tad concerned the guy made the assumption of blockage rather than bleed. So difficult, and he's gone the logical route, but I'm just not sure about sending a case like yours home with some pills. But still, the symptoms seem to be fading, and the vessel scan is really good news.
License? You should tell the folk in the big grey cube.
I often think laterally to the point of absurdity, but is there anything you could have eaten that might contain some exotic drug? Raw fish from the the far east comes to mind. It's so odd that the symptoms covered such a wide area, yet left so many other functions unaffected.
Keep us informed.
There's so little the layman can say, and you seem to be fast-tracking the medical system, and that's good. I'm a tad concerned the guy made the assumption of blockage rather than bleed. So difficult, and he's gone the logical route, but I'm just not sure about sending a case like yours home with some pills. But still, the symptoms seem to be fading, and the vessel scan is really good news.
License? You should tell the folk in the big grey cube.
I often think laterally to the point of absurdity, but is there anything you could have eaten that might contain some exotic drug? Raw fish from the the far east comes to mind. It's so odd that the symptoms covered such a wide area, yet left so many other functions unaffected.
Keep us informed.
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I'm 56
No exotic drugs (!) and no strange food.
No strange activies either - I was on the phone when it happened and just continued as normal for another 10 minutes or so until the call ended naturally
At the moment (nearly 48 hours since the event) everything still works and nothing has dropped further than it's gradually been doing over the last 20 years. There is still slightly reduced sensation and tingling in the left side of the lips, teeth and tongue, as well as the L thumb.
Thinking back - some years ago I had a severe pain in the L side of my face (around the eye and including the lips, teeth and tongue) which became a reduced sensation and tingling before fading naturally after a couple of weeks or so - various tests were done but no problem was found. Many years ago I had long-term problems with a tingling right pinkie and thumb but this was put down to a slight calcium outgrowth on one of the vertebra in the neck touching the spinal column - the tingling went away by itself.
No exotic drugs (!) and no strange food.
No strange activies either - I was on the phone when it happened and just continued as normal for another 10 minutes or so until the call ended naturally
At the moment (nearly 48 hours since the event) everything still works and nothing has dropped further than it's gradually been doing over the last 20 years. There is still slightly reduced sensation and tingling in the left side of the lips, teeth and tongue, as well as the L thumb.
Thinking back - some years ago I had a severe pain in the L side of my face (around the eye and including the lips, teeth and tongue) which became a reduced sensation and tingling before fading naturally after a couple of weeks or so - various tests were done but no problem was found. Many years ago I had long-term problems with a tingling right pinkie and thumb but this was put down to a slight calcium outgrowth on one of the vertebra in the neck touching the spinal column - the tingling went away by itself.
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If this is something to do with a trapped nerve or a spinal issue, maybe a chiropractor could help you out? They can manipulate your spine a bit and maybe free something up.
Or perhaps a physio if they can x ray your spine and see if there is anything odd going on? I had dreadful sciatica for a while (pain and numbness in my lower back and right down my left leg and foot) and a few sessions of physio sorted it right out.
Good luck.
Or perhaps a physio if they can x ray your spine and see if there is anything odd going on? I had dreadful sciatica for a while (pain and numbness in my lower back and right down my left leg and foot) and a few sessions of physio sorted it right out.
Good luck.
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Bald Rick,
I would not be surprised if whatever caused you to suffer pain and numbness on your left side several years ago is probably the same culprit as now.
I would not be surprised if whatever caused you to suffer pain and numbness on your left side several years ago is probably the same culprit as now.
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Happened to someone I know who was a pilot, sudden onset, he went numb on one side and fell off his motorbike. He was diagnosed with MS but last I heard he got his medical back.
Good luck.
Good luck.
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Brief update:
Last night the headaches caused by the Persantin were the worst headache or pain I've had in my life so I've told the consultant that I can't tolerate it and will not be taking any more. From looking-around there seem to be alternatives without the side effects so if he still judges that I need something I assume he will re-prescribe.
There' still no loss of any function but the sensation in my lips, tongue, teeth and thumb are still not as they should be on the left side.
CFI - thanks for the info. I'm pretty sure that I wouldn't have fallen-off because everything seemed to carry-on as normal, but I'll investigate in that direction
The blood test results came back as "all normal" (with a cholesterol level of 4.5), as did the doppler scan of the carotid arteries - the initial MRI feedback was also OK.
From doing a lot of looking around I'm now strongly suspecting that this was a neurological event, rather than a vascular one. Can anyone suggest how I can educate myself enough (presumably about the CNS) to ask the right questions?
B Rick
Last night the headaches caused by the Persantin were the worst headache or pain I've had in my life so I've told the consultant that I can't tolerate it and will not be taking any more. From looking-around there seem to be alternatives without the side effects so if he still judges that I need something I assume he will re-prescribe.
There' still no loss of any function but the sensation in my lips, tongue, teeth and thumb are still not as they should be on the left side.
CFI - thanks for the info. I'm pretty sure that I wouldn't have fallen-off because everything seemed to carry-on as normal, but I'll investigate in that direction
The blood test results came back as "all normal" (with a cholesterol level of 4.5), as did the doppler scan of the carotid arteries - the initial MRI feedback was also OK.
From doing a lot of looking around I'm now strongly suspecting that this was a neurological event, rather than a vascular one. Can anyone suggest how I can educate myself enough (presumably about the CNS) to ask the right questions?
B Rick
Can I ask what physical shape you are in?
Are you carrying more weight than usual?
Had any recent back or hamstring issues?
Neck problems?
Increased stress?
Regular exercise?
The reason i ask is that I have had a back/disk issue due to scar tissue from broken ribs near where the spine meets them, which has caused some numbness and tingling from time to time, but by getting remedial massage, losing 10 kg and strengthening my back and stomach muscles I have been free of the sensations for a while now..
Good luck..As someone at the start if his career i hope to get lucky and have 30 years + at like you..
Are you carrying more weight than usual?
Had any recent back or hamstring issues?
Neck problems?
Increased stress?
Regular exercise?
The reason i ask is that I have had a back/disk issue due to scar tissue from broken ribs near where the spine meets them, which has caused some numbness and tingling from time to time, but by getting remedial massage, losing 10 kg and strengthening my back and stomach muscles I have been free of the sensations for a while now..
Good luck..As someone at the start if his career i hope to get lucky and have 30 years + at like you..
Reassuring that the objective tests were normal.
I think the diagnosis will need unravelling by your neurologist. I'm wondering if migraine is the most likely diagnosis.
I think the diagnosis will need unravelling by your neurologist. I'm wondering if migraine is the most likely diagnosis.
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Yes, it's still early days but it's reassuring from the viewpoint that a stroke is something I really don't want (unless it involves a slightly younger female 
) but I'm starting to get concerned that this could end-up with a default "can't find anything so let's call it x" - and if the x chosen was migraine it would probably have the same effect on the licence as stroke or TIA.
Without any other symptoms would migraine really be a likely diagnosis?
Weight - not too bad, but dropping from 80kg to 70kg would not be a bad thing.
Neck problems - yes, but 40 years ago!
) but I'm starting to get concerned that this could end-up with a default "can't find anything so let's call it x" - and if the x chosen was migraine it would probably have the same effect on the licence as stroke or TIA.Without any other symptoms would migraine really be a likely diagnosis?
Weight - not too bad, but dropping from 80kg to 70kg would not be a bad thing.
Neck problems - yes, but 40 years ago!
Yeh I can see your point. If someone diagnosed migraine in myself, it wouldn't matter a hoot, for you guys, it could be a disaster.
Although it's good news that the tests are normal, you are now venturing into one of the most dangerous aspects of medicine - expert opinion.
It's important that your neurologist knows about the impications for your career. Unfortunately, what will twitch the guys at the CAA is the fact that your limbs were involved. On your side is the fact that you have been thoroughly investigated, and your symptoms appear infrequent and transient.
Good luck.
Although it's good news that the tests are normal, you are now venturing into one of the most dangerous aspects of medicine - expert opinion.
It's important that your neurologist knows about the impications for your career. Unfortunately, what will twitch the guys at the CAA is the fact that your limbs were involved. On your side is the fact that you have been thoroughly investigated, and your symptoms appear infrequent and transient.
Good luck.
Some of this lady's symptoms sound similar to your original posting.
BBC News - 'Rare disease means I may wake up unable to move'
Hopefully not though, as it is similar to MS.
BBC News - 'Rare disease means I may wake up unable to move'
Hopefully not though, as it is similar to MS.
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"Intravenous contrast?" - no, nothing was injected.
Some news today - on closer inspection one MRI image apparently shows a small area "half the size of a peanut" in the "sensory bulb" which could account for the initial hemiparesthesia (I assume that's the correct term) and the residual small regions of reduced sensation (L thumb, L teeth, L lips). Supposedly an older scanner would not have shown it ... I have a nasty feeling I may wish I had gone somewhere with a lower-resolution scanner!
It's still very early days, but some of the questions that are starting to go through my mind are: could this be a technical error? could it be a misinterpretation of the data? is it a major problem? is the finding likely to lead to permanent loss of medical?
B Rick
Some news today - on closer inspection one MRI image apparently shows a small area "half the size of a peanut" in the "sensory bulb" which could account for the initial hemiparesthesia (I assume that's the correct term) and the residual small regions of reduced sensation (L thumb, L teeth, L lips). Supposedly an older scanner would not have shown it ... I have a nasty feeling I may wish I had gone somewhere with a lower-resolution scanner!
It's still very early days, but some of the questions that are starting to go through my mind are: could this be a technical error? could it be a misinterpretation of the data? is it a major problem? is the finding likely to lead to permanent loss of medical?
B Rick
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Sorry to be straight forward: the low resolution scanner doesn't change whatever is in your head, it might just not make it visible. So the better scanner is really the better option.
To your questions: hard to answer. It could well be a technical error, there are partial volume artifacts and a whole variety of other things in MRI, but to really judge this one would need to see the images. This could also be the case with misinterpretation. But from my understanding of what you have written, there was this small area, which is rather a description than an interpretation. Interpreting this might be challenging with what is currently available. From what you have written, it might be interesting to check whether the blood - brain - barrier is disturbed in this area (hence the question for i.v. contrast). I am sure, the neuroradiologist taking part in your medical work up will suggest the best way to further look into things.
Keep asking until you have an acceptable explanation!
To your questions: hard to answer. It could well be a technical error, there are partial volume artifacts and a whole variety of other things in MRI, but to really judge this one would need to see the images. This could also be the case with misinterpretation. But from my understanding of what you have written, there was this small area, which is rather a description than an interpretation. Interpreting this might be challenging with what is currently available. From what you have written, it might be interesting to check whether the blood - brain - barrier is disturbed in this area (hence the question for i.v. contrast). I am sure, the neuroradiologist taking part in your medical work up will suggest the best way to further look into things.
Keep asking until you have an acceptable explanation!
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Thanks for the info Rory and there's absolutely no need to apologise for being straightforward - it's the only way to be in my book. My comment about scanner resolution was an attempt at humour from an aviation perspective; there's no doubt that if something's wrong it's better found earlier.
Well, the "small area half the size of a peanut in the sensory bulb" now has a name, it's a "right internal capsular small stroke due to a blood clot". Methinks bugger would be an appropriate adjective at this point!
I grounded myself when it happened but will have to tell the CAA now that the problem has a name - is it feasible to regain a class 1 after an event like this if there are no other changes? or is it gone "at a stroke" (I promise not to retrain as a stand-up comedian).
B Rick
Well, the "small area half the size of a peanut in the sensory bulb" now has a name, it's a "right internal capsular small stroke due to a blood clot". Methinks bugger would be an appropriate adjective at this point!
I grounded myself when it happened but will have to tell the CAA now that the problem has a name - is it feasible to regain a class 1 after an event like this if there are no other changes? or is it gone "at a stroke" (I promise not to retrain as a stand-up comedian).
B Rick
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I'm sorry to hear that, but now you know your enemy! And may be some of the other possible diagnoses wouldn't be that much better...
JAR-FCL 3 isn't very specific about your issue, but (as I understand it, not being AME) it allows reevaluation of a class 1 after a SINGLE episode if a definite reason can be established.
This is most certainly what I would do anyhow, independently of the medical.
Now, one important thing: you did NOT have a stroke, it was a TIA (transitoric ischemic attac), because it lasted to short for a stroke and went away by itself.
Unfortunately, a TIA is associated with an increased risk of stroke over time, with ~5% within 1 week, ~10% within a month and 15-20% over 90 days. And that is what you really don't need.
The cause of the TIA is a very small blood clot from somewhere else in the body traveling to the brain and clogging a small vessel. That's where it makes sense to tackle: the most common areas where these clots come from are: the carotic bifurcation, the heart (valves, atrium), and the aortic root. This is pure cardiologists land and it probably would be a good investment to go there.
Now it gets a bit more tricky: certain types of vascular diseases and certain types of treatment can interfere again with your medical. So if there are findings which offer therapeutic alternatives, get advice from an AME, what from a flying perspective woudl be the preffered treatmen.
That is the pure medical part. But what else you can do, is at least as important.
Get rid of your risk factors!
Get your BMI in a normal range, do some sports. That doesn't need to be high intensity, even 3 times a week a 30 minute walk helps. Didn't your wife wanted to do that tango dancing since years? Would most certainly qualify.
And have a look at your nutrition. I personally do not like the current standard approach: low protein, low fats, no fun. Recent scientific evidence even suggests, that this aproach is counterproductive, but to be honest, the books aren't closed on this topic. Do some reading on low carb, may be it could be fitted into your lifestyle.
Stop smoking (if you do) and limit alcohol (but still have fun!).
And finally, as you never know, what happens next, make sure you and your wife know where the closest stroke unit is and have copies of your recent findings at hand. Because if things run bad, time is brain!
JAR-FCL 3 isn't very specific about your issue, but (as I understand it, not being AME) it allows reevaluation of a class 1 after a SINGLE episode if a definite reason can be established.
This is most certainly what I would do anyhow, independently of the medical.
Now, one important thing: you did NOT have a stroke, it was a TIA (transitoric ischemic attac), because it lasted to short for a stroke and went away by itself.
Unfortunately, a TIA is associated with an increased risk of stroke over time, with ~5% within 1 week, ~10% within a month and 15-20% over 90 days. And that is what you really don't need.
The cause of the TIA is a very small blood clot from somewhere else in the body traveling to the brain and clogging a small vessel. That's where it makes sense to tackle: the most common areas where these clots come from are: the carotic bifurcation, the heart (valves, atrium), and the aortic root. This is pure cardiologists land and it probably would be a good investment to go there.
Now it gets a bit more tricky: certain types of vascular diseases and certain types of treatment can interfere again with your medical. So if there are findings which offer therapeutic alternatives, get advice from an AME, what from a flying perspective woudl be the preffered treatmen.
That is the pure medical part. But what else you can do, is at least as important.
Get rid of your risk factors!
Get your BMI in a normal range, do some sports. That doesn't need to be high intensity, even 3 times a week a 30 minute walk helps. Didn't your wife wanted to do that tango dancing since years? Would most certainly qualify.
And have a look at your nutrition. I personally do not like the current standard approach: low protein, low fats, no fun. Recent scientific evidence even suggests, that this aproach is counterproductive, but to be honest, the books aren't closed on this topic. Do some reading on low carb, may be it could be fitted into your lifestyle.
Stop smoking (if you do) and limit alcohol (but still have fun!).
And finally, as you never know, what happens next, make sure you and your wife know where the closest stroke unit is and have copies of your recent findings at hand. Because if things run bad, time is brain!
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BMI: 26. BP: 143/85. Non-smoker. Alcohol: 7 units/week max, usuallly less. Exercise: I'm already a dancer and use an exercise bike weekly, but not much else. Diet: reasonable. There's certainly scope to reduce weight and increase exercise!
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.
Out of interest, is there an easy/quick test for PFO?
Regarding knowing where the nearest stroke unit is: good advice but it's going to be tricky because there's a batch of foreign travel (as a PAX!) coming-up soon.
This has been a wake-up call to me, although possibly too late. I hope that some of those reading this who have been thinking about getting on the exercise bike or getting the weight down will now take action.
B Rick
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.
Out of interest, is there an easy/quick test for PFO?
Regarding knowing where the nearest stroke unit is: good advice but it's going to be tricky because there's a batch of foreign travel (as a PAX!) coming-up soon.
This has been a wake-up call to me, although possibly too late. I hope that some of those reading this who have been thinking about getting on the exercise bike or getting the weight down will now take action.
B Rick
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Hey Rick
Just wondering did you get any shots before this happened in your arm. Myself and a buddy of mine before going overseas got our shots and loss feeling in our left to fingers and tingling down the arm nothing in the lips or anywhere else but we both had the same thing happen to us. Just a thought.
Just wondering did you get any shots before this happened in your arm. Myself and a buddy of mine before going overseas got our shots and loss feeling in our left to fingers and tingling down the arm nothing in the lips or anywhere else but we both had the same thing happen to us. Just a thought.