Ongoing Symptoms Post-Stroke Despite Normal Imaging Results
A 68-year-old male, standing at 6'3" and weighing 180 pounds, presents a complex medical history. He has a history of atrial fibrillation for which he underwent ablation therapy. He also has benign prostatic hyperplasia and is scheduled for surgery soon. His history includes five transient ischemic attacks (TIAs) and two strokes, yet all imaging, including CT angiography of the carotids, appeared normal, aside from a previous mention of a lacunar infarct that has not been referenced in subsequent evaluations. Currently, he is on medications including Apixaban, Rosuvastatin, and Tamsulosin. A significant event occurred a few months back when he experienced sepsis following a prostate biopsy. The patient has noted instability upon standing from a seated position, often veering to the right. Despite this, he maintains an active lifestyle, playing golf three times weekly, adheres to a healthy diet, abstains from alcohol, and is averse to smoking, although he uses a vape. My husband continues to face challenges following his latest TIA/stroke. He frequently experiences persistent symptoms including weakness on the left side, slowness in speech, and difficulty retrieving words—although he describes being able to visualize them mentally, verbalizing them proves challenging. This TIA occurred merely weeks after he recovered from the sepsis episode. While he is capable of walking and communicating and seems generally well, he struggles with significant left arm weakness and discomfort when lifting. Additionally, there are signs of muscle wasting, particularly in the upper arm. Fatigue is a constant issue, and unless he takes a nap, his speech difficulties tend to resurface; however, he feels better after resting. Yesterday, we spent considerable time in the emergency department where blood tests, an ECG, and a CT scan were conducted, all returning normal results. An MRI of the head and neck was performed too, but the outcomes will be available on Monday. Depending on those results, a referral might be necessary to a stroke clinic or further to neurology. We would greatly appreciate any insights or recommendations regarding potential inquiries we should make or additional tests that might be needed. Thank you for your time and consideration!
Answers (1)
8/16/2025, 8:31:07 PM
OpenHealth AI
Thank you for sharing such detailed information about your husband’s situation. It's understandable to feel concerned given his history and ongoing symptoms. Here’s a summary of the main points followed by a structured explanation and actionable next steps.
Main Points:
- Your husband has persistent symptoms following a TIA and stroke, including left-sided weakness, speech difficulties, and fatigue.
- Imaging and tests conducted have returned normal results, but his condition warrants ongoing monitoring and evaluation.
- Questions regarding further inquiries or tests are important for addressing his symptoms.
Explanation:
After experiencing a TIA or stroke, it’s common for patients to have lingering symptoms as the brain heals. The symptoms your husband reports, such as weakness and difficulty with speech, can stem from a variety of mechanisms — including muscle weakness due to inactivity, neurological deficits, or fatigue-related cognitive issues. The emotional and psychological impacts of a stroke can also contribute to feelings of frustration or fatigue.
While the imaging results have come back normal, it’s crucial to continue evaluating his symptoms, particularly as they might fluctuate in severity. The mention of muscle wasting and fatigue indicates that attention may be needed not only on neurological health but also on physical rehabilitation and supportive therapies.
Next Steps:
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Monitor Symptoms: Keep a detailed journal of his symptoms, noting any changes in strength, speech clarity, and fatigue levels throughout the day. This record can be invaluable in future discussions with healthcare providers.
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Follow Up on MRI Results: Once you receive the MRI results, discuss them comprehensively with the healthcare team. Ask about the implications of the findings and whether they provide any possible explanations for his ongoing symptoms.
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Physical Rehabilitation: If not already in place, consider involving a physical therapist who specializes in post-stroke rehabilitation. They can develop a tailored exercise program to help improve strength and mobility, particularly for the left side.
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Speech Therapy: Referral to a speech-language pathologist could help him with communication difficulties. They can provide strategies to improve word retrieval and clarity in speech.
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Fatigue Management: Encourage regular rest periods throughout the day. It can also be useful to develop a structured daily routine that includes engaging yet low-energy activities, so he feels active without overexerting himself.
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Address Muscle Wasting: Discuss with the healthcare provider the possibility of nutrition and strength training support. A dietitian can help optimize his dietary intake to support muscle health, especially after episodes of illness.
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Inquire About Neurological Follow-Up: Regardless of the MRI results, inquire whether a referral to a neurologist or a stroke clinic is appropriate for comprehensive stroke management.
If you have specific questions about his medications or any potential side effects, or if new symptoms develop, those are important to discuss promptly with the healthcare team. Please remember that you're doing a great job navigating these challenges, and supportive resources are available to help enhance your husband's recovery journey.
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