[48M] With confusion, numbness, and suspected stroke symptoms

Patient Description

A 48-year-old male has been experiencing confusion and difficulty putting words together for the past three weeks, which worsens when standing or talking. These symptoms have been constant and came on gradually. Additionally, he has been dealing with tingling numbness and partial loss of feeling in his feet for over a year. He reports sharp headaches, vision changes (glasses no longer work for seeing far away), and dizziness or loss of balance. He believes he might have had a stroke last year, during which he experienced numbness on the left side of his face, difficulty moving his lips, and an inability to engage in conversation for a few seconds. This episode resolved quickly but has caused ongoing concern. His medical history includes Ehlers-Danlos syndrome (diagnosed in 2022), high blood pressure (since 2000), and high cholesterol (since 1988). He had a total knee replacement in 2020. He recently started taking new blood pressure medications, Meloxicam and Amlodipine, and has noticed feeling light-headed since starting them. His current medications include Levothyroxine (0.175 mcg), Metoprolol (50mg), Losartan (50mg), and Hydrochlorothiazide (50mg), all taken once a day. He does not have any allergies to medications and does not use tobacco, alcohol, or recreational drugs. Family history includes a father who died of a heart attack, a mother who had a transient ischemic attack (TIA) and is diabetic, and a grandmother who had a stroke.

Arora's Assessment

What might be happening

Based on the symptoms and history you've provided, here are some possible explanations for your condition:

1. Stroke or Transient Ischemic Attack (TIA)

Rationale: The episode you described last year, where the left side of your face became numb and you had difficulty moving your lips, could have been a TIA or a mild stroke. These events can cause temporary symptoms that resolve quickly but are serious warning signs.
Typical Testing: Diagnostic tests like a CT scan or MRI of the brain, along with blood tests and possibly a carotid ultrasound, are often used to evaluate for stroke or TIA.
Typical Treatments: Treatment may include medications to manage blood pressure, cholesterol, and prevent blood clots, as well as lifestyle changes and possibly physical therapy.

2. Medication Side Effects

Rationale: The light-headedness and confusion you are experiencing could be side effects of your new blood pressure medications, Meloxicam and Amlodipine.
Typical Testing: Your doctor may review your medications and possibly adjust dosages or switch medications.
Typical Treatments: Adjusting or changing medications under medical supervision.

3. Peripheral Neuropathy

Rationale: The tingling and numbness in your feet could be due to peripheral neuropathy, which can be associated with conditions like diabetes or Ehlers-Danlos syndrome.
Typical Testing: Nerve conduction studies and blood tests to check for underlying conditions.
Typical Treatments: Managing the underlying condition, medications to relieve nerve pain, and physical therapy.

4. Cognitive Impairment

Rationale: The ongoing confusion and difficulty with word formation could be related to cognitive impairment, which can have various causes including vascular issues, medication side effects, or other neurological conditions.
Typical Testing: Cognitive assessments, brain imaging, and blood tests.
Typical Treatments: Addressing underlying causes, cognitive therapy, and possibly medications to improve cognitive function.

What you can do

Stroke or TIA Concerns

Immediate Action: Seek medical attention as soon as possible. Even without health insurance, many hospitals offer financial assistance programs. Early intervention is crucial.
At Home: Monitor your symptoms closely and avoid activities that could put you at risk of injury due to dizziness or confusion.

Medication Side Effects

Immediate Action: Contact the healthcare provider who prescribed your new medications to discuss your symptoms. They may need to adjust your dosage or switch medications.
At Home: Keep a detailed journal of your symptoms, including when they occur and their severity. This can help your doctor make informed decisions.

Peripheral Neuropathy

Immediate Action: Schedule an appointment with a healthcare provider to discuss your symptoms and possible tests.
At Home: Ensure good foot care, avoid tight shoes, and consider using a foot massager to improve circulation.

Cognitive Impairment

Immediate Action: Seek a referral to a neurologist for a comprehensive evaluation.
At Home: Engage in cognitive exercises, such as puzzles or memory games, and maintain a healthy diet and regular physical activity.

What you should look out for

Given the severity of your symptoms and the possibility of life-threatening causes, you should seek medical care as soon as you can. Reasons to seek care even more urgently include:

Sudden worsening of confusion or difficulty speaking
Severe headache or vision changes
New or worsening numbness or weakness in your limbs
Fainting or severe dizziness

Remember, while I can provide information and suggestions, it's crucial to consult with a healthcare professional for a formal diagnosis and treatment plan. You can use MDandMe to journal your symptoms, track progress, get insights, and share longitudinal medical notes with your provider.