Surreal. He was surrounded
by cardiologists at a Cardiology Congress in Tokyo, Japan. The speaker, an 80-year-old Caucasian male cardiologist,
was giving a presentation when something went wrong. I looked around my seat, and
we were all in a state of disbelief. As seconds ticked by, I was impatiently
waiting for one of my colleagues to attend to the ailing speaker, but no one
did. After speaking with several afterwards, they (cardiologists) did not immediately
recognize the symptoms.
It was May 2018. The
presenter was speaking in English, an acquired, non-natural language. His
English was sharply accented, but intelligible, and he had a deep knowledge of
the subject matter. After about 6 minutes into his presentation, the following
- He was unable to read his monitor, nor the overhead screen it was presented on.
- His hand/eye coordination with the computer mouse went awry (the cursor went wild).
- His speech was mumbled, unintelligible.
- He was incoherent for ~4 minutes.
And then he somehow seemed to understand where he was in
his presentation and stumbled through the next few screens until mercifully,
the presentation ended. The stunned convention attendees did not ask any
Approximately 4 hours later, this person appeared
perfectly normal and actively engaged another presenter with insightful
questions and banter.
What Happened? (possible diagnoses)
My guess: a TIA (Transient Ischemic Attack)
. Unlike a stroke, TIA symptoms resolve within 24 hours.
Also, unlike a stroke, a TIA does not tend to
kill brain tissue or cause permanent disabilities. The worries with a TIA are
that it could turn into a stroke, or be an early warning sign for a full-blown stroke.
The speaker did have a podium, but I do not recall seeing any left-sided
weakness or facial drooping. The speaker’s age also aligns with TIA risk factors
(it rarely happens in younger people). I have no knowledge of his medical history, but given his age, he could have
hypertension and possibly diabetes – both risk factors for a TIA.
Other specific symptoms
which further indicate that he
experienced a TIA include:
- Weakness, numbness or paralysis in the face, arm or leg (typically on one side of the body)
- Slurred or garbled speech - or difficulty understanding others
- Blindness in one or both eyes - or double vision
- Dizziness or loss of balance or coordination
- Sudden, severe headache with no known cause
Although these symptoms are nearly identical to those
seen in an ischemic stroke, they are experienced in a shorter duration and usually
end a few minutes after the blood flow returns in the blocked artery. According
to Mayo Clinic, they generally don’t cause any permanent brain damage unlike a
true stroke. What’s interesting, is that symptoms can differ depending on what
part of the brain was affected from the blockage.
Risk factors for ischemic strokes and TIAs both include:
family history, age, sex, sickle cell disease and race. Those with family
members who have experienced a stroke or TIA are at a much greater risk. Risk
also increases with age, especially after 55. Men are more likely to experience
them, but women are more likely to die from them. People with sickle-cell
anemia are more likely to experience them because their irregular blood cells
are more likely to stick together and clot. Black men and women have a higher
chance of experiencing a stroke because of their higher predisposition to this
disorder, as well as a higher prevalence of high blood pressure and diabetes,
which I will dive into now.
Besides high blood pressure and diabetes, the risk factors
mentioned above can’t be controlled.
However, other ones can be by making healthy lifestyle choices. Higher
blood pressure (>140/90 mm Hg), higher cholesterol, high levels of
homocysteine and a high body mass index (BMI>25) all correlate to a higher
risk of stroke or TIA. Also, those with cardiovascular disease, carotid artery
disease, peripheral artery disease or diabetes have a higher risk, along with
those who are inactive, smoke, drink, use drugs or don’t follow a healthy diet.
Everyone should attempt to improve their overall health by minimizing the
effects of these conditions, or by eliminating them all together, and by
avoiding unhealthy activities. Unfortunately, the alteration of hormone
balances that comes with ingesting oral contraceptives also increases the risk
of TIA/stroke, so this should be discussed with one’s physician, especially
when considering different forms of birth control.
20% of suspected TIA’s end up being migraines
. However, migraines usually have
a gradual onset and decline. A TIA usually starts abruptly, and is followed by
a gradual offset (typically over minutes). Migraines also usually last 10-30
minutes, but can last several hours. TIA's almost always last under 1 hour.
The migraine time frame did not match the
speaker’s episode. Migraines are also characterized by a severe throbbing pain
located in the head, and accompanied by extreme sensitivity to light and sound.
Attempting to continue the presentation would have been nearly unbearable for
him. I never asked him what happened though, as that may have been
inappropriate and certainly awkward.
normal duration of seizure is up to about 5 minutes.
This would almost perfectly match the episode
the speaker had (~4 minutes).
there was no complete speech arrest for him, nor were there any involuntary
movements. A seizure would have been much more frightening, and he likely
would’ve collapsed and lost consciousness - which would have spurred people to
So, a seizure can be ruled out.
3. Syncope (temporary
loss of consciousness due to reduced blood flow to the brain, or fainting): The
normal duration of syncope is a few seconds, which is a lot less time than the
speaker’s episode of ~4 minutes. However,
the symptoms do mimic TIA:
- Dimmed vision
- Muffled hearing
- Retinal & cochlear hypoperfusion (possibly caused by postural hypotension)
(an “isolated complete and brief speech arrest”
): I can relate
to this, as I try to speak Japanese and Spanish when abroad. Also, similar to
this is a panic attack brought on by increased anxiety, however these victims
are usually aware and able to recover quickly.
Kevin Fitzpatrick, MBA, has authored or co-authored >300
medical and disease-state tools. We specialize in cardio-metabolic tools and
have created custom Stroke, CHF, CHD, Diabetes, Hypertension, ASCVD, AAA, PAD,
and Arrhythmia risk calculators.
Brock Fitzpatrick is a senior at the University of Wisconsin, College of Letters and Science