multi TIA's

Brain and nerves
21

Hi,

Sorry to jump in here. But I have my patient records from my hospital stay, along with CD images of my CT scan, but there is no copy of any readout or report from my scan. There are some handwritten comments in my what I would call bedside notes, but nothing that could even be vaguely called a direct report from the CT scan.

Should one exist and do I need to go back and ask? I always thought it funny that there was nothing specific from it. Even my ECG at the time mentioned infarct - I know that is for a different part of the body, and relates to a different phenomenon.

22

Hi, very informative yet again and thanks, I am now very much more enlightened.

​The answers to your questions :- I live with my hubby, who incidentally helps me to compose these emails. No falls, but I do have sever osteoarthritis in my neck and elsewhere, and I come under Walsall, West Midlands, the Manor.

​I have been back to the doctors and have asked them to send a referral  letter direct to the stroke clinic at Manor hospital Walsall, but, whilst they have agreed to do this for me, they say that the 'choose and book' request is already at the Manor and that it is doubtfull that the referral letter will get any better response.

​Thank you so much, you have been a great help to me.  Regards  Carol

23

Hi Carol,

Here's the link for the Acute stroke service page for Manor Wallsall.

https://www.walsallhealthcare.nhs.uk/acute-stroke.aspx

It won't come up as a clickable link here, but you can copy and paste it into your web browser address bar , right up at the top left, where it will currently say "patient.info/forums...... I found it by googling "manor wallsall stroke service". As you can see, they have TIA clinics every morning and GP's can refer you directly to the service via the hospital switchboard.

If you've had 2 CT scans then not sure why (if the first one showed an infarct (s) you weren't referred then, and why after the second CT scan, the memory clinic didn't refer you straight away. I know this is difficult enough for you, but I would strongly consider making a complaint. Perhaps you have a son or daughter who can support you in this if you and your husband don't feel up to it. Please let me know how you get on. Best Wishes, Susan

24

Sorry Carol, but felt it important to add this. Age is irrelevant. The average age of stroke patients is around 70, although more people are having strokes at a younger age because of the increase in the incidence of Type 2 diabetes, high Cholesterol and BP in young people. We gave thrombolysis (the "clot busting" drug which has to be given within 3 hours of the onset pf stroke symptoms) to a 90 year old lady who came into A/E with a severe stroke. She was previoulsy fit and well and was the main carer for her disabled husband. She had no movement in her right arm or leg, and couldn't speak and couldn't understand what was being said as the stroke had affected the "dictionary" are of her brain.Within 30 minutes of being given the drug she started to improve and she walked off the ward  2 days later with only minor word finding difficulties and some mild weakness in her hand . I'll always remember because she was such a great success story, but also because she had very long, thick hair, pinned up in a bun with old fashioned hair grips. We were trying to the CT scan done very quickly as the sooner the clot buster is given the better. I think we took about 30 hair grips out of her hair, as she couldn't go into the scanner with any metal. Each time we thought  we had them all, we'd find another hiding away somewhere.

 

25

I think the type of stroke has a massive bearing on the age. I had a bleed on the brain at 48 and having read up on it, more people of a younger age have cerebral haemorrhages.

26

Hi,

I'm assuming that things were prety crazy when you went into hospital with your SAH? The Docs were probably given a verbal report on your scan by the radiologist, or they , as neurosurgeons would be very capable of interpreting it. This is probably "the scribble" in your notes. Nowadays, Docs can log into the Xray system and read the formal report that's written by a radiologist ( a Doctor who specialises in all aspects of Xray and scans). There should also be a printed copy of this official report stuck in your notes, usually on a separate page with other X-ray and scan results. Clinically nowadays a SAH isn't classified as a stroke, as it doesn't have the same risk factors,or require the same treatment. Likewise they don't require the same intervention to prevent another. Usually SAH are caused by a rupture of an artery where there was a congenital ( present at birth) weakness,unless of course they occur because of a bang to the head. They tend to run in families and are most common in middle aged women.

A myocardial infarct ( heart attack) would show up on an ECG.

27

'I'm assuming that things were pretty crazy when you went into hospital with your SAH?'

Yes and no, it wasn't what I was sent in for, even though I thought it was the reason my GP sent me straight to A&E whilst ringing up the hospital to speak to the bed manager.

If you're interested, I'll explain tomorrow, in a bit more detail. I accept your understanding of an SAH, although it was ICH which I think is slightly different. Size 2.2 x 4.0 x 3.5cm and a 6mm midline shift for good measure. It was a rupture of an artery caused by unchecked hyperension with other circumstances, no family history and I'm definitely male - there is still ongoing discussion about whether trauma played its part.

The ECG says; Consider anteroseptal infarct.

I've a gastroscopy at nine in the morning tomorrow (which should indicate there were other problems) and I'll repost tomorrow if necessary.

28

Sorry, I thought you said you'd had a SAH. Yes, an intracerebral haemorrhage is different as the bleeding is inside the cerebral tissue. A SAH occurs outside the brain tissue. Nasty, especially with all that midline shift.

Consider anteroseptal infarct means that whoever reported on the ECG thought there was a possibilty that you'd had a heart attack. Good Luck tomorrow.

29

My apologies if I used the wrong terminology, I though bleed on the brain could refer to either ICH or SAH, it then just depended or where the bleed was that decided which one it was.

Warwick hospital that orginally had me for the first 12 hours, have now said (through PALS) that they are not sure and for me to contact Coventry (PALS) as to the exact nature of the stroke, which I find strange as they were the ones that did the CT and diagnosed me. I didn't get the radiologist report with my patient records and I have now asked Warwick (PALS) to provide it (especially as I had to pay £25 for my records for a 12 hour stay).

I have also asked for more info on the infarct ref ECG, as there is no follow up on that. I would have thought at some stage someone would have checked up on it and even if it was nothing, they would have written that into my notes. I think I am not their favourite person now. I am always polite, and I don't know why my records shouldn't state clearly about the stroke and that soem followed up the ECG even if just to confirm it was negative.

On the positive side, the gastroscopy was a walk in the park and it said that my oesophageal varicies have gone.

30

Hi, what exactly are you complaining about via PALS? It seems that you know that you had a Primary ICH and what  caused it

"Size 2.2 x 4.0 x 3.5cm and a 6mm midline shift for good measure. It was a rupture of an artery caused by unchecked hyperension with other circumstances, "

31

What I meant was that the fact that Carol was 73 shouldn't affect her treatment and investigations as ischemaic stroke and TIA tend to affect more older people, and here in the UK at least, it's Consultant's with a background in elderly medicine who care for them.  Primary ICH and SAH are different ball games as SAH nearly always requires surgical or interventional radiological treatment, and more often than not, so does Primary ICH,and this would fall under neurology/neurosurgery.

32

Carol, I wrote you a long post last night, but for some reason it was referred to the moderators and still hasn't been posted here. I found the contact details for the stroke specaikist nurses at Wallsall manor just be searching for "Wallsall Manor Stroke Service" i google.

I also found a bulletin which the hospital service sent to GPs in September 2011 regarding how to refer TIA and stroke patients directly , by fax or telephone , to the stroke team. Search for" Wallsall manor GP stroke referral bulletin". in google, it's the top result.

They shoiuldn't be writing letters ar using Choose and Book system. They just need to pick up the phione. I am sorry that you're going through this. You should;ve been referred directly to the Stroke or TIA team when whoever it was got your CT result. I want to stress that it's very important that , by any means possible, you're seen by the team. Go to A/E and tell them you had a weak arm but it's worn off now, but you had a CT scan over 2 weeks ago which shows you've had 3 TIAs and you haven't been seen by a Stroke Consultant and watch how fast they move. Best Wishes, Susan.

33

That is my understanding from reading the notes. I have never been told much. I have asked the hospital to confirm that it was in fact a stroke, as opposed to a trauma to the head. They have come back and told me they can't tell me (they don't know) and have suggested that I contact the hospital that I was transferred to, even though the first hospital did the CT and the radiologists report has not been included.

The stroke rehab hospital say that it wasn't a stroke and asked crass questions like, did you have a fight the night before. I have pointed out that nowhere in my notes, X-rays or CT scan does it show signs of trauma. Which is why I wanted a chat with a doctor to go through it. I may not be medically qualified, but I have held fairly senior management psoitions and I know how you present the facts.

To give you an idea of the sort of things they have omitted to mention, a blood plasma transfusion, even though I am down as alert and orientated in my notes, nor was it communicated to my wife. I ony found out later by accident when the gastro was worried about my bloods and was contemplating a cancer marker test and asked me if I'd ever had a blood transfusion, to which I was about to say no, when he said, of course you have, we gave you one here. I'm sure they're meant to ask the patient or next of kin (who was in constant contact with the hospital) for permission before they do that sort of thing.

There are so many things I have not been told, more than I have mentioned here. I just feel, that it is important to know whether it was a stroke or trauma that caused a bleed on the brain and also, if by some small chaance I suffered a minor heart attack at some time, I feel that that is also important to know.

I haven't complained to anyone, I asked PALS for their help after purchasing my patient records. The fact that I have asked for the radiologist's report and what was the follow up if any about the ECG, I think has mildly irrated them, but I thought that was what they were there for.

My file on the gastro side, seems to have got put aside, because the gastro left and no one ever looked at it. The follow up on possible haemochromatosis was not done, I found out about the cancer test by accident and had to write in and ask for the result. The liver US, OGF and repeat bloods were never done. It was only when I got my patient records a couple of months ago, I started to find out things like this. Then had to get an appointment and ask for the long overdue tests to be done.

I am not complaining, I am merely asking people for answers, answers to what I think are fair questions.

34

Hi Susan, yes, I was eagerly awaiting release of that link, unfortunately not happened yet. tried googling the other suggestions but have not quite found what you seem to have found. Good suggestion though regarding weak arm, many thanks again

35

Use the correct spelling and don't use the quotation marks.

Walsall Manor Stroke Service

if you still can't find it, ask misswoosie to PM the links. All links get modded automatically and many never get released or not in a timely manner. I never post links anymore, just the Google info or PM the links to the person.

 

36

Yes, You're correct re spelling RHGB. How can I send a PM to Carol please?

Have gone to her profile page but don't see anywhere where it says send a message? Thank you.

37

Underneath her avatar is a picture of an envelope, click on that. You won't have an envelope under yours because you can't PM yourself - I say that, because it is the first thing everyone does, is look for their own envelope. You have one and I can see it because I could PM you. You will see one under my avatar but I cannot see it.

If ever you can't see the envelope of someone, it is because they have turned off PM in their privacy settings.

38

Sorry, I;m a little confused. Surely you would know if you had been subject to any trauma to your head before the haemarrhage happened. If there was no trauma then why are they saying it may have been caused by trauma? In the notes, in the medical examination, does it say "signs of trauma to the head" ie bleeding, a big lump" If there was no trauma then it was a spontaneous Intracerebral haemorrhage. Did you go into hospital with problems with bleeding from your GI tract, or problems associated with your liver?

If you're in hospital, then you are consenting to certain treatments, otherwise what would be the point of you being there? If you were in intensive care then you're consenting to treatments commonly associated with intensive care. If you were unwell, which it sounds like you were, and perhaps you were beeding, and your clotting factors were reduced,or your protein and albumin levels were low, then giving you a plasma infusion could have been classed as life saving and would not have required formal consent. I can see and appreciate that things may not have been done, and sometimes medical professionals aren't wholly non-discriminatory of certain groups of people. For example, my GP discriminates against me because of my age (post menopausal), history of "depression" and  ex senior nurse status. Basicaly she things I'm either mad or a Hypochondriac or both! Others recently have been the same ( we;ve moved twice since returning from the USA and had to change GPs since ). It disgusts me that they won't even take a proper history and do a clinical examination. Nurse Practitioners could do a better job for a quater of the salary of a GP.

I would try to get the notes from the hospital where you attanded A/E (I assume).

If I sometimes mis spell or my grammar is incorrect then I apologise. I have my own health problems for which I've had to pay for private bloods, and tring to get those sorted.

39

Thanks RHGB. Done it , but still won't let me put in a clickable L. Wonder if it would let me put the HTML code for the link in? I'll try sending to you

40

Susan, thanks again, latest :- My husband has spoken with Sandra, Dr Epstein's secretary, long conversation, but the best that has come out of it, is that there is a slot at the end of July with Dr Epstein, and she has sent an email to the booking dept, telling them this, in the hope of them allocating this slot to me. Best she could do! what a mess!

Best regards  Carol