In ER Friday with TIA/Stroke Symptoms

On Friday at breakfast I had what seemed to be some TIA or stroke symptoms. My vision got strange for 1-2 minutes, then I had a headache for three hours, and felt off balance and a bit nauseated for rest of the day. This is what I saw: While looking at the 10 foot away kitchen cabinets, at 5 feet high and above, the cabinets appeared to have on them a matrix of 2" clear circles, each centered 4" apart. The area inside each circle appeared distorted. Below 5 feet the bubbles also had distortion, but were not nearly so dense. I've never had that before.
I phoned my surgeon’s office (Dr. Hongo), and his RN told me that my symptoms were a red flag, and that it was urgent to go to my PCP the same day. My PCP said to go to the ER, so I ended up at Marian Hospital in Santa Maria all afternoon. The doctor was concerned that I might have had a TIA or stroke, and he included a CT brain scan to check for brain bleed, an EKG, and blood work, which all came back normal. By then, my headache was gone, but I still was off balance and a bit nauseated. The doctor said it sounded like a migrane headache, but since I've never had one before, and I’ve just had heart ablation surgery, this seems unlikely. The doctor said that if the CT scan showed evidence of brain bleed, I would not be leaving the hospital, but would be transferred to neurology for possible surgery.
He said to come back if my symptoms reappear. This morning I woke up at 4AM with a headache, pressure on my forehead, being off balance, and a bit nauseated again. I still felt this way at 10AM, but didn't want to go back to the ER as the doc said the next step might be a spinal tap, which I definitely don't want!! Now at 5:30PM, I am feeling better but still a bit off balance.
Any ideas as to what is going on? I am taking 20mg of Xarelto and 37.5mg of metoprolol, but neither of these have caused a problem during the past month I was taking them.
Thanks much,
Nancy M

Nancy, did the ER suggest seeing a retina specialist since your CT scan was normal? Since your vision was different at 5 feet and above, than below 5 feet, it sounds a lot like a possible retina detachment. Do you have any kind of floaters in your vision? I'm sure Shannon or someone else will have better suggestions than I. But, I think you need a quick resolution to this.

Take care,
Jean

Some of your symptoms are consistent with orthostatic hypotension. Have you checked your blood pressure?

Nancy:

I sometimes do get Aura Migraines, it will distort my vision for about 1/2 hour then clears, I don't get a bad headache just sort of feeling not as peppy as I did before the Aura, I see a sort of zigzazzy lights when it happens.

I don't know what you had, but if you never had that before and you did just had an ablation, go to the hospital if you have anymore odd feelings.

Take care
Liz

HI Nancy, so sorry to hear of your scare on Friday but very glad to hear it wasn't a delayed stroke or TIA after the CT scan, blood work and exams came back.

Aura Migraines for those who are prone to them, and even for some having them the first time, can happen in the days after an ablation s well Nancy. And since the blood work and CT scan ruled out a stroke or TIA that is a possibility Nancy.

Migraine and Catheter Ablation for AFIB The theory is that these fairly uncommon but not unheard of, occurrences in the days after an ablation might be associated with the transeptal puncture. Did Dr Hongo say anything about whether you have a PFO (Patent Foramen Ovale) or not, which is a congenital hole in the septal wall of the heart that is somewhat common? People with those are prone to a certain type of headache with odd visual disturbances Ive been told and apparently a similar effect can happen after a transeptal puncture and they are transitory and not a worry, but can be a bit unnerving happening so close to an ablation.

And with some of your other metabolic challenges it would also make sense as well.

Morpheus' idea of orthostatic hypotension symptoms match with some of what you described, but the duration of your event seemed longer than most Orthostatic Hypotension episodes which are usually precipitated by standing too fast after laying down or reclining in the presence of low adrenal insufficiency, such as very low cortisol or even Addison's disease.

With your very low weight for your height Nancy, and the many other symptoms you have described previously that at least, in part, could reflect a strong adrenal issue, I want to ask if you have ever been thoroughly screened for Addisons or primary adrenal insufficiency? Im not saying that is what this is by any means, only that some of your prior symptoms and your some aspects of your current symptoms also could fit into that pool. Orthostatic Hypotension is also a classic finding in Addison's or primary adrenal insufficiency or secondary adrenal insufficiency.

Again, that standard test is a specific ACTH challenge test called a Synacthen or Cosyntropin test. However, I wouldn't suggest that particular test for you right now right after an ablation as it can cause some real side effects one of them being a racing heart beat, particularly with your high sensitivity to so many substances. But other more benign tests like a 24 hour adrenal hormone profile along with a straight ACTH and 7:30 AM serum cortisol as well as aldosterone and DHEA sulfate test could still pretty much define a significant deficiency in this area, without the risks for someone like you of a Synacthen test. If anyone suggests a Synacthen test, be sure they give you the "LOW DOSE SHORT ACTING" version of the test for sure! That would be easier on your body and is better overall anyway.

If that is what is happening here to any degree, it could explain a lot of what you have described previously as well.

Were you lying or sitting for a period of time and then suddenly stood up when these symptoms first happened?

DO like Liz and Jean said though, if anything more like this happens go to the ER and also ask then to consider your low weight and describe any issues with difficulty in weight gain and fatigue, tiredness, nausea, easy susceptibility to colds or infections etc, which can all be signs and symptoms of adrenal insufficiency as well.

If a person has borderline low to frankly low adrenal out put and then has a significant surgery or procedure, it is very possible to create a mini cortisol crash that can manifest, at least in part, with some of what you are saying Its too bad I can't see you, but any good doctor should be able to sleuth this out, even if you sometimes have to point their nose in the right direction by pointing out the clear possible signs with low weight, any all day fatigue, periodic nausea or frequent sensitively to medications or supplements, and some foods. immune system challenges with frequent colds or flare ups etc. Also chronic conjunctivitis and other systemic inflammation signs are common.

Is you skin darker than others on your direct relative side of your family like a brownish tinge or specifically darker brown pigment around your elbows and/or knees? Do you have particularly deep set eyes as well with sometimes dark circles under them? Any issues with arthritis or occasion skin irritations or hives?

Anyway, these are all just a few of the red flags for a potential core adrenal issue, especially in a low weight situation for one's height. In addition, its amazing to me how often this is missed too in standard physical exams.

The main thing now though, is any return of the blurred or skewed vision and dizziness with headache, get back quickly to the hospital. I would not think anything embolic is going on with the Xeralto on board and a full week after the ablation, but you can't rule it out from a distance,so dont delay if the symptoms return.

You may well be fine too Nancy and most likely are and this was just a blip that won't return as you continue regaining your recovery strength.

Sleep well.
Shannon



Edited 1 time(s). Last edit at 03/09/2014 02:37PM by Shannon.

Scans, bloodwork, etc,, don't necessarily eliminate the possibility of stroke or TIA. Those tests only reduce the probability.

My father had a stroke...it was rather obvious...the confusion...vision problems in one eye...yet the barrage of tests yielded nothing.

When he went to visit his eye doctor a week or two later, one of the first things the doc asked was "Did you have a stroke recently?"

"Doctors can see representative brain cells in the optic nerve when they examine your eyes-making them a window into your brain. By examining your eyes, a doctor can often detect diabetes, high blood pressure, arterial plaque, multiple sclerosis, brain tumors, stroke, leukemia and many other conditions. That makes getting a thorough eye exam one of the best ways to have your brain personally audited for bigger problems that can affect you down the road."

Although it sounds like you may have had aural migraines (I have had a few myself), it wouldn't hurt to see a good opthamologist (who would also be, by training, a retinal specialist) very soon.

I had migraine aura right after my ablation, with big circular splodges and zig zags in my vision which grew and faded away in the space of 30 mins. I did not get the headache though but was still groggy from the GA for quite a few days - took me a while to feel normal. Happened about 3 times in the week after then went away for good. My EP said it was indeed connected to the septal puncture but he said no one could explain why there is an association. Then just a few months ago I had a lot of dots in my vision and similar to what you describe lots of tiny circles grouped together which distorted my central reading vision as any lines were 'warped' then a large 'Weiss ring' appeared in my right eye, so emergency trip to optometrist and it turns out my vitreous was detaching in my right eye - apparently all part of the good old aging process (I am 54). Right eye is OK now but those little circles are now in my left eye so I guess it is following suit. Hope you are OK and its something along these lines do go see the optometrist !

Nancy

You know I had my PVI two weeks ago and about day 9 I had an AURA Migraine. We have snow on ground in KY and just all the brightness next thing I know I was seeing a swirling circle in my vision. I have only had one of these before. But anyway that is a good possibility

Hi Everyone,

Thanks so much for your help. It is wonderful to hear of others' experiences because it makes me aware that the same could happen to me after this recent ablation, especially since I had a second similiar episode on Tuesday, which was again scary.

Shannon, my nutritionist found the same Mayo Clinic study you referenced about trans-septal puncture from ablation surgery causing new onset migraines, and sent it to me. After reading it and your explanation, I felt better that what I was having was not a TIA. When I spoke with Dr. Hongo yesterday for my 2 week follow-up, I asked him about this, and he said this could be what is happening to me. The good news is that he says the hole in the septum is extremely small and closes within 2 to 3 months, so if this is the cause, my symptoms should go away by then.

And thanks to everyone's insistence, I did go to an opthalmalogist who is also an internal medicine doctor on Tuesday to have my eyes checked out. He said my retina and eyes are in good health, and he added that he is 100% sure that I have been having visual migraines. He says they often come in clusters, so I may have more over the next couple weeks. He also said that I may continue to experience disequilibrium for days or a couple weeks as a result of them too.

Shannon, I did go to an endocrinologist about a year ago to have him explore why I have chronic insomnia. He did what seemed a thorough workup and ruled out Addison's. I remember he did an ACTH test, but I don't know if it is the one you mentioned. Unfortunatley after all his testing, he said he couldn't find a reason for my insomnia. When I saw my nutritionist on Monday and told him about my episodes, he also suspected Orthostatic Hypotension, so he tested for it with positional blood pressure. He had me lie down and took my BP and it was 121/62, pulse 84. Then after lying there for a couple minutes, he had me stand up. My BP was 98/60, pulse 80, and he concluded that I did have Orthostatic Hypotension, but we were in such a hurry to do other testing, that I never found out what to do about this. I continue to be off balance at times, but not just when I get up from lying or sitting. I seem to be that way off and on during the day. Some of this may be due to metoprolol. When I went off the metoprolol just before surgery, I felt so much better. My thinking cleared up and so did my balance. I'm on 37.5mg right now, and Dr. Hongo said we will be reducing that in the near future.

Thanks again for everyone's help and concern.

Blessings to all,
Nancy

Nancy, the only real symptom I'm having almost 7 weeks after ablation is orthostatic hypotension. Used to have it during afib...but been in complete NSR since ablation. Shannon mentioned above that OH could be due to adrenal insufficiency. I just got the results of my 24 hour adrenal hormone test and there were several low values all consistent with adrenal insufficiency. Time to take steps to restore my adrenals. The cause of your OH could be different than mine, hope yours is just due to metoprolol. I'm on no meds except flecainide and Xarelto, and was under prolonged high stress going into ablation so not surprised at the adrenal hormone results. I ran a continuous migraine for 3-4 days after ablation. Once it ended, I haven't had any more so far...despite a history of migraines...seems ablation may actually have helped them.

Thanks for sharing this, Randy. Hopefully, my migraines will be short term also. Glad to hear that your migraines are actually doing better after ablation.

What is the name of the 24 hr Adrenal Test you had done? Sounds like I need to get one done too. Did you have it done through an endocrinologist?

Nancy M

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Edited 1 time(s). Last edit at 05/10/2014 08:47AM by morpheus.

Morpheus, what is your comment above in reference too almost two months after the last post?

I'm trying to get the context here for your post and the relevance to the topic of the thread above?

Shannon