TIA or migraine? only god knows.

i had my appointment with the neurologist this morning.

he had me recount the whole episode, and then he did an abbreviated series of reflex tests (banging on my knees and elbows with that odd-looking device at right, known as a "queen's square hammer"), took my pulse and listened to my carotid arteries. he confirmed that i was overall very healthy (reiterating that my MRI, MRA and ECG all looked normal) and that i wasn't at risk for stroke.

what was also interesting was that he indicated that i wasn't really at risk for migraines, either. he said a woman my age just doesn't start having severe migraines out of the blue... that someone who experienced a migraine so severe that it caused speech loss would likely have had a long history of headaches, beginning perhaps as early as high school.

i told him i remembered having a series of severe headaches in the spring of 2005, but even that wasn't enough to convince him that what i'd suffered in november was a migraine. he said migraines can indeed cause a lot of the symptoms i had (aphasia, light sensitivity, a sense of disconnecteness), but to suffer a migraine this severe -out of the blue- was pretty weird.

actually, he probably didn't say "pretty weird." he was much more professional than that.

if i had a TIA, though, he said it's very odd that i didn't also have any associated facial numbness or tingling, since that's all pretty connected in the brain. to have speech difficulty without facial numbness is out of the ordinary.

he also said that i'd experienced many triggers for migraine that night... i'd been traveling and may have been dehydrated, i didn't have any dinner, and i was listening to loud music ("classical music," he said, "can still probably get pretty loud, right?"). but then he followed that up by saying, "i'm guessing, though, that you've skipped dinner then seen a concert before, and nothing like this had happened."

and he's right about that.

i mentioned that i'd had some chocolate at intermission, and he practically interrupted me, saying that there had been extensive research into this area and that he can definitively say that chocolate does not cause migraines. he said in the clinical trials patients were given chocolate and others were given something that simply tasted like chocolate, and the incidence of migraine was the same in both groups.

so YAY for chocolate!

bascially he was stating cases for and against the likelihood that the episode in november was caused by either TIA or migraine. "here's an argument why it was migraine... here's an argument why it wasn't. here's an argument for TIA, here's an argument against." in the end, he told me that because i don't exhibit any risk factors for TIA *or* migraine, the safer course of action was to assume that i had suffered a TIA. and in assuming that, we have to also assume that the cause was VERY atypical since all of the standard tests have so far come back normal. we'd have to really dig for a cause.

he therefore ordered another series of blood tests ("to rule out any coagulopathy") and scheduled a follow-up appointment for six weeks.

i liked this doctor. i appreciated that he's taking the more challenging route (TIA) rather than just falling back on a diagnosis of "atypical migraine" and letting it go. i still feel like there's a damn good chance that we'll never know exactly what happened, but at least we're looking at every possible option.

what i DIDN'T like was the guy who drew my blood. i walked into the lab and he was watching something on google video. i made the mistake of asking what it was, and he said that he and his wife were considering opting their children out of the teaching of evolution at school. "evolution is just a lie, you know." i almost laughed in his face, but then realized that he had a sharp needle in his hand. he went on to tell me that in school they teach children that humans evolved from rocks. "and that's just crazy!" he said. "if we evolved from rocks, that took millions of years. and that was just *man*! women have different organs, and that would have taken another million years of evolution!" he said the man in the video he was watching was the expert in this controversy over whether children should be taught evolution in the schools. i was stunned that he would be allowed to watch that (at such a loud volume) in such a public area of his workplace.

so i just shut my mouth, and as the rubber band around my bicep was starting to feel more and more constrictive i silently willed him to stop talking and draw my blood already. finally, during a pause in his tirade, i said, "this is starting to feel uncomfortable..." he said one more thing about how it would make his children 'school outcasts' if they had to leave the room each time a teacher brought up evolution, then he finally jabbed me with the needle.

that whole thing was really weird.

Posted by xta at December 7, 2006 11:05 AM | TrackBack