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MRI is all clear, now what?
stajoc posted:
I am a 24 year old very healthy female. I run about 30 miles a week, have no issues with hypertension, and have no chronic conditions aside from lumbar scoliosis and a benign thyroid tumor. No known history of migraines.

I have had five instances of TIA-like episodes since 2007 and they seem to have increased in severity over the years. The first time it happened I was watching a movie at a friend's home and I completely lost my vision and felt confused.

The fifth (and so far, the last) time was much worse- I was walking across my kitchen and felt like I was being dragged down to the left, if that makes sense. I felt like I couldn't step toward the right and literally walked into a wall and slumped down. At the same time I felt dragged to the left, I felt like I couldn't support myself on my left leg. I has pretty severe vision loss and could only somewhat see out of my right eye. My entire left side was numb and I had left-sided facial drooping (per my boyfriend) and was slurring my speech. I remember feeling very confused and nothing was making sense. I did not have insurance at this time and as the symptoms started to wane, I decided if they completely went away within the hour that I would not go to the ER. The symptoms did go away, and so I did not go. The following day, I had some residual numbness in my left leg and had some difficulty walking, but that went away as well.

This episode was in September of 2010, and I haven't had an episode since. I got a job with health insurance shortly after, and in November, set up a primary care doc and expressed my concerns about this. She sent me for a brain MRI and I waited for the results. After about a week, I received a call from the radiologist at my physician's practice telling me the MRI was clear. I tried calling my doctor 3 times afterward to try to see if that was all we need to do or if we should look into this further or what; I have not received a call back from this office, and frankly, I will not be going back.

My question for all of you is: should I talk to another doctor or leave it as is considering the MRI was all clear? What would you do?
Richard C Senelick, MD responded:
Your question provides an opportunity to not just talk about your problem but also the recent stories about Serene Branson. She is the the televsion reporter who lost the ability to speak while reporting a story "live" on television. Everyone jumped on the fact that she did not go to the hospital for a complete stroke evaluation.That certainly seemed like appropriate criticism at the time of the event. It subsequently came out that she had a history of "complicated migraine" and because she had previous episodes, she knew what was going on.She was quickly back to normal and did not need further testing becuase the cause of "her" symptoms had already been established.

Complicated migraine is a condition where the person has "stroke like" symptoms that may or may not be followed by a migraine headache. The first time they occur, they certainly deserve the attention of a TIA, with a complete work up. The diagnosis of complicated migraine is made after it has been established that a true TIA or stroke has not taken plece. A typical migraine may be preceded by flashing lights, blurred vision or numbness that last 10-20 minutes. In complicated migraine, the "aura" of preceding symptoms may last longer and have more neurologic symptoms. Like Serene Branson, patients can become aphasic and temporarily lose the ability to speak. The good news is that the symptoms resolve. If they occur frequently enough, there is medication to try and prevent the attacks.

Your story sounds like "complicated migraine." However, to be certain you need to have a thorough evaluation by a neurologist who would take a complete history and then perform tests to eliminate the causes of a stroke ina young woman. It is certainly good news that your MRI is normal, but there is a group of other tests that may be needed. Rather than give you a long list of "possible" tests, you are better off seeing a neurologist who, based on your history, will know which ones to perform. This is mandatory. Do NOT stop with just this information.

The good news is that you are reaching out for help and information. Do not stop until you get a complete evaluation.
stajoc replied to Richard C Senelick, MD's response:
I truly appreciate your reply! I suppose I will try to get a referral to a neurologist. Thanks again!

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