Hemiplegic Migraine or Minor stroke???

Hi - this thread was started as a coffee break chat - but I think its such a good discussion thread it deserves its own thread.....

wildone wrote:

One thing they did notice was how my eye brow on my right side had dropped and wondered if one of my "hemiplegic migraines" was actually a tia stroke, which could have been last weekend. Its one question I have always asked when is a HM not a HM but a small stroke........and no one can answer that for me, especially as I have a history of strokes.

Graham

Tee wrote:

The TIA vs HM is an interesting question - I too have had both and often wonder - the only thing I have found reported - is that HM builds up, so you get a weakness somewhere first, that gets worse, but a TIA is sudden. Must say I knew I had had the last TIA as the numbness / pain in my head was totally different...... but HM is so like stroke.... its a hard one to call....

Tee x

Sheena Hulston wrote:Its all so hard I had no TIA (am assuming thats a clot?) although they did no lumber puctur to check at the time but my right arm leg hip mouth and eyelid and sometimes bottom eyelid can drop weekly!!!! I thought that's what happened with everyone's aura on hemaplegic migraine!!!! What is everyone else's "AURA" like then?
hope all goes well x x
Sheena

My auara is with me 24/7 and has been for 5yrs - I call this my 'normal' auara and the only thing that changes is the severity of it. I see visual auara all the time, small dots, a little worm (whom I have named bob!) and the worse - vasaline vision - it is hard to explain but its like you view the world through a lense which has vasaline smeared on it. I also have a weakness in my left arm and hand and numbness in my left cheek, my eyelids have also dropped.




Now when I have over done it, I also get a weakness in my left leg, the visual auara gets worse and the numbeness in my cheek spreads to my ear, nose and mouth including my tongue. My speech goes and I loose words, lack of concentration kicks in and I cannot think for toffee. Alice in Wonderland then kicks in as can depersonlisation - It is normally at this point I am flatout in bed!!.



When I had my first massive HM I could not walk - my balance had gone too, also when they put cotton wool in my eye I did not react.




When I had the TIA - it was more studden - Its a bit harder this one to explain, as I had just had a c section and a bad bleed - I had been pumped full of gel (to stop the bleed) and was on a lot of morphine............ but the difference was that the numbness in my head was both sided - if you think of a head and cut it through at the nose - like cutting an egg - the numbness was at the top part only - this would happen as I was in the verge of sleep. Within mins my left side went, my face dropped, and I had a massive numbness in my left face - like I had just come back from the dentist - I mouth was hanging and I was dribbling, I could not talk. Doctors run tests and found the whole of my left side had a weakness - I could not test this, as I could not walk anyway - as I also had acute SPD! But I did not leave the hospital bed for 8 days and when I did it was via a wheel chair - then once home I did not leave the bedroom for 9 weeks. If was a big day when I managed to walk down the stairs. It took me 2.5 years to get my 'thinking' back.

Not sure this answers the question - but thisis what the Stroke Association has to say.....
http://www.stroke.org.uk/information/our_publications/factsheets/migraine.html

Very interesting what you say there Tee, I had a representitive from the Stroke Association visit me last year and we talked about the Stroke vs Hemiplegic Migraine syndrone, and as they said its hard to differ between the two, especially if you have history of strokes, and as I said before there is no one rule, just intuition and my wife knows when to call for an Ambulance.

Its better to be safe than sorry, even the doctors have said the same and its not a waste of time for peace of mind.

Graham

Hi Tee this is interesting, I also get the cotton wool reaction but I thought is was because of the loss of sight in right part of eye! I also get amazing flashing at night when Im tired,cant follow a line of writing easily and LISTEN to the telly as opposed to watching it now as it blurres and causes pain.
I too took two years to come back to myself lost my balance and could not focus on conversations.
Was turned away from my a&e with stroke like symptoms so strange how different NHS areas work!
Cant fig out what AIW syndrome is, is that when you feel lost and detached and those times when you wander and feel lost? Cause I get that before I have a really bad spell of pain!
Getting really bad sinus trouble at mo and found out that can be part of aura too.
Went through a stage of no smell and taste as well that was bad.Then smelling weird things! maybe that was meds!
Sure there is a lot more but cant think today Only deal with Dr S now as only Dr I trust. I ring him if I need anything or if I felt I was in any doubt. Im sure my Healthcare trust will listen to him.
Sheena

Graham- your quite right - if in doubt - go to A&E. You sound like you have an amazing wife. Does the recovery period differ for you from a stroke to HM?

Sheena - I can relate to a lot of what you have said. I do not watch a lot of TV either, I seem to be able to do the PC but not the TV, think its something to do with the movement.

AIW is when parts of your body feels bigger than it is -its a perspective thing - its quite an amazing thing to have happen - it always amuses me - I am strage I know - but it does not hurt - I only get it in my hands and face and only when I am laid down and they feel about a meter in size - so not a little bit big but huge.

The distance thing you mention may be depersonalisation - that is when you seem to float along and things look and feel surreal.

I found an artcile on sinsus and migraine today funny enough - I will post it for you.

Also smelling things that are not there is another aura.

I am even with you re Dr S - such a nice man.

Tee

Oh by the way - did you know that Lewis Carol had migraine and its thought that is what inspired Alice in Wonderland!


This link explains a bit better http://www.aiws.info/

how is TIA diagnosed? is it done by cat scan or MRI or just symptomatic? x

As far as I know - a TIA is diagnosed by history and physical examination. Most attacks recover before a doctor sees the patient, so its a hard one to spot. But the line between a TIA and a HM is a very hard one to draw and I have yet to have an answer from a doctor to explain the difference. I do know in most a cases, most people undergo tests (ie CAT or MRI Scan) on their first HM in order to rule out other stuff.


The examinations for a TIA may include:

Assess mental status to make certain the patient is alert and oriented.

Check eye range of motion and facial movement to evaluate the cranial nerves (the short nerves that run from the brain to the face and neck).

Listen to the neck with a stethoscope to detect abnormal sounds that may signal narrowing of the blood vessel (carotid bruits).

Check for a regular heart rhythm to rule out the presence of atrial fibrillation.

Examine the arms and legs for tone, power, and sensation.

Check coordination and balance.


If the diagnosis of TIA is made, further urgent testing is usually recommended, including:

Electrocardiogram (EKG) to confirm a regular heart rate

Computerized tomography (CT scan) of the brain to look for bleeding

Carotid ultrasound to look for narrowing of the large blood vessels in the neck

Routine blood tests may include a complete blood count (CBC) to look for anemia or low red blood cell count or too few platelets (thrombocytopenia). If the patient takes warfarin (Coumadin), a blood thinner, then an international normalized ratio (INR - a blood test that measures the degree of blood thinning) or prothrombin time (PT), may be performed to assess blood clotting measurements.

If there is concern that the heart is the source of blood clot or debris, then an echocardiogram or sound wave tracing of the heart may be considered.


Hope this helps. Tee

How many people on this forum have had a stroke as well as hemiplegic migraine? I have been shocked to hear of so many, I had read that there was an increased risk of stroke but didn't think it was that much of a reality, I know my grandad had them and he died of a stroke in his 50's.

I think there is 3 of us???? Sheena, Graham and myslef. Either TIA or stroke - but there maybe more - memory is not too good today.

There is also something called migraine stroke - this explains it a little better than I can tonight -
http://www.ehow.com/about_5079928_migraine-stroke.html

What the stroke association say:
http://www.stroke.org.uk/media_centre/press_releases/migraine_and.html

This is a good news paper article on it: http://news.bbc.co.uk/1/hi/health/8327869.stm

Thanks that explains things a bit better.
Jane
x

Thats really useful thank you, very good articles.

I am however slightly concerned that now having had aura form a migraine attack at the start of May still occurring that puts me in the class of having a migraine stroke!

I have asked my GP to refer me to the migraine clinic at Bath as I haven't seen anyone since diagnosis of HM in 2007/8.

Please do not panic. I get aura everyday, and have done for 5 yrs, it does not mean I am constantly having migraine strokes. I just have persistent aura. But if this is the first time this as has happened to you, you should get it checked out. So yes I think a referral would be a good idea - also meds, treatments and even the understanding of migs, have changed since 2007 and you should really be getting at least an annual review of your medication.