Transient aphasia and right side numbness, silent migraine?

Posted by bshariati @bshariati, Oct 24, 2023

New here and looking for help. My husband (65y/o) started having mild intermittent numbness in his right leg in 2017 and later progressed to his right arm. Not debilitating and not often. In 2020 he had an acute event of right side numbness, difficulty speaking and was taken to the ER. All symptoms resolved quickly and all scans and tests were clear but they diagnosed him with a TIA. Cardiology found nothing exceptional except age-related atherosclerosis. 30-day Heart monitor results were unremarkable. He saw 2 neurologists, one had no answers but the other one diagnosed silent migraine and prescribed low-dose propranolol. After several months, the right side numbness continued and they stopped the medication. In January 2023 he had another similar event. All symptoms resolving quickly but we went to the ER just in case and again they diagnosed TIA. No specific treatment except for lifestyle change (he is a smoker). April 2023 he had another event with "electric" sensation in his right arm and difficulty speaking. These events last less than 30 seconds but another trip to the ER with no further treatment. We saw another neurologist who is a TIA specialist at U Chicago who rejected the TIA diagnosis, checked for seizures (negative), couldn't give a diagnosis but recommended a neurosurgeon for his chronic c-spine stenosis. September 2023 he had involuntary arm movements only that lasted seconds. October 2023 he had difficulty speaking (couldn't recite the alphabet past "h" and couldn't enunciate certain words) that lasted ~10 minutes. Neurosurgery appt today was negative for any c-spine involvement with these symptoms. Since the event in April, he has chronic right side tingling and numbness, fatigue, brain fog, and has subtle word finding and speech difficulty (he says "like my jaw doesn't want to work"). Never any headache pain during these events (although he did have painful headaches as a teenager). Does this sound like a silent migraine? Anyone else have similar stories?

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Not exactly the same but my diagnosis is definitely worth "googling". I had left side numbness in 2020 which went up my side and resloved going down the same path in about 15 min, hospital MRIs, CT scan, blood work, carotid artery scans all came back fine I was sent home with TIA diagnosis. a few months later I had left side face numbness for 15 min then a few weeks after that left side hand numbness that traveled from thumb to finger and then resolved in the same manner. Fast forward to 2023 when I had a right side episode that did involve my face and speech but traveled up the body and resolved traveling down all in about 20min. Same diagnosis (TIA) at a different hospital. Two weeks later it happened again, went to a more well known hospital where I got a lot of testing including angiogram of brain. Still nothing found however I am now diagnosed with possible CAA (Cerebral amyloid angiopathy). It's not well known. I went to Mayo clinic here in FL and the neruologist agreed with diagnosis. It can be verified with a brain biopsy but that's not worth the risk according to the Dr. I am on anti seizure (Keppra) meds. I tested neg for seizures through multiple EEGs however the Keppra does seem to be keeping the "episodes" at bay. I am going to Mass. Gen Hospital in March (earliest appt. available) because they actually have a unit devoted to CAA trying to pinpoint causes and possible cures.

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Hello Sue @suemaltais, welcome to Connect. Thank you for explaining your health experiences beginning with left side numbness. It's helpful that you shared, especially with a rare diagnosis.

Wow, it's definitely confusing when there are mitigating circumstances. You certainly went through some trying times. My mother recently has had TIA episodes, it's scary to not know the why behind the what right away. I'm glad you've gotten closer an accurate diagnosis. I hope you feel somewhat relieved to have a possible diagnosis especially one that Mayo Clinic has agreed with.

Good news that seizure medication is keeping symptoms at bay, and even better news that you're going to Mass General! Will you come back and post about your future experiences with CAA?

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Yes I certainly will report any updates.

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@suemaltais

Not exactly the same but my diagnosis is definitely worth "googling". I had left side numbness in 2020 which went up my side and resloved going down the same path in about 15 min, hospital MRIs, CT scan, blood work, carotid artery scans all came back fine I was sent home with TIA diagnosis. a few months later I had left side face numbness for 15 min then a few weeks after that left side hand numbness that traveled from thumb to finger and then resolved in the same manner. Fast forward to 2023 when I had a right side episode that did involve my face and speech but traveled up the body and resolved traveling down all in about 20min. Same diagnosis (TIA) at a different hospital. Two weeks later it happened again, went to a more well known hospital where I got a lot of testing including angiogram of brain. Still nothing found however I am now diagnosed with possible CAA (Cerebral amyloid angiopathy). It's not well known. I went to Mayo clinic here in FL and the neruologist agreed with diagnosis. It can be verified with a brain biopsy but that's not worth the risk according to the Dr. I am on anti seizure (Keppra) meds. I tested neg for seizures through multiple EEGs however the Keppra does seem to be keeping the "episodes" at bay. I am going to Mass. Gen Hospital in March (earliest appt. available) because they actually have a unit devoted to CAA trying to pinpoint causes and possible cures.

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Thank you @suemaltais
He has another neurologist appt tomorrow and I will bring it up. If you don’t mind me asking, did/do you ever have any chronic symptoms like fogginess, fatigue, tingling after these events?

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No I didn’t really have any chronic symptoms once the event cleared. Occasionally my arm or jaw would continue to feel a little different , sort of heavy after the event, but within an hour it would all resolve.

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After I had my first grand mal seizures I developed right side weakness so bad I could barely walk for first few days this was 30 years ago. The "great" PCP I had at the time because I could actually move thought I had "hysterical paralysis" mental illness was just beginning as the new answer to everything wrong. Ten years later w/ my license back my right side weakness ( and now 49) a little better, no cane needed, turned out I was having continuous seizures even though on anti- seizure meds,& I was driving but these were "non-epileptic" seizures I was driving when I had one took my foot off the gas pedal and abruptly slowed down (not stopped) but the fast moving card behind me did not a big accident ( I was on a major highway) the Highway patrol officer took my license away I never tried to get it back. The next thing, forward another 20years to 5 mos ago my new young doctor at Stanford he is around 35 a clinical professor and my PCP decided after two hospitalizations in two months one for seizures and one for "toxic" 🙁 levels of Lamictal he thought maybe he would do a MRI of the brain. Now they had been done before but not for general wellness diagnosis for a patient with a plethora of illnesses. Well it turned out I had lots of indications of TIAs. I was considered a patient with a history of TIAs and do you know what until the day that young doctor no other doctor at Stanford had used those letters or the word stroke and I was 69 almost 70. So there are seizures that may mimick strokes stokes that can cause seizure at the same time or later on. and there are atypical seizures, non-epileptic seizures and epileptic seizures and that is just kind of general over view of them starring, a hand jerk, pause long than usual all can actually be seizures just different types and you can have them for hours but when you get right next to the doctor and they do an EEG & they find nothing if you wonder don't you could bet right but do not think you are wrong I was at Stanford and they had a hour long seizure measured by the EEG I was there for 5 days and nothing happened again they did a MRI ( did not tell me about the TIAs) and a lot of other thing. My neurologist up there calls me a puzzle I think because I have a lot of different types of seizures. I do not know if this helped you anyone but maybe someone

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Here's another diagnosis for ya'll to look up: Hemiplegia Migraine. It is genetic and can be Familial or Sporadic. The main thing is that it must have a paralysis, either right side or left side, that accompanies the rest of the attributes. Aphasia is typical (wibble-wobble speech), confusion, vision problems, seizures - usually non-epileptic but sometimes just jerkiness, and all this is often, but not always, followed by a humdinger of a migraine. Then a couple of hangover days. All this can happen inside two or three hours, days or weeks. I had to sign some paperwork the other day and I couldn't remember how to spell my name !!! Most medical staff will try to diagnose you with a TIA, but the difference is: a TIA comes on suddenly like a thunderclap whereas HM will slowly hit you, giving you enough time to sit down and get some rescue medicines into you. I take anti-convulsant and anti depression medication daily plus I carry my rescue meds with me.

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