Can You Give Me a Diagnosis?

Someone I know was rushed to the Er because she lost her sight for a brief period of time (in both eyes, not just one) and it was followed by tingling limbs. After a hospital stay and extensive testing, she was diagnosed with migraines. But she has never gotten a headache like she thought a "real" migraine would feel like. She says she feels foggy and out of sorts the two times it has happened.

And my grandfather suffered from mini strokes. It took a really long time for him to be diagnosed. He had pain and tingling, no loss of sight or hearing.

The blindness happened to my FIL. He was coming out of a store and he said it just looked like an overcast day at first then it got very dark for a few mins. He was having another test when my mil mentioned the episode.
They did a test to see the blockages in his carotids. One was almost completely blocked. That was the problem. They cleared it out and he lived several more years in good health till he died of a heart attack in his sleep.

I hope this helps.

It is so hard to know. I'm not a doctor, but I know there is such a thing as a mini-stroke or transient ischemic attack (http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001743/

According to this info from the NIH, TIAs will not show up on a brain scan, so this would make sense with what they told him. And the symptoms match.

He needs to make an appointment with his doctor to discuss this possibility.

On a side note - at one point when my grandpa was getting up there in age, he had a problem with his knee. His doctor tried to ignore it and said, well, you are 70 now. My grandpa's reply - My other knee is 70 too, and it doesn't hurt so figure out what's wrong! My grandpa was awesome.

I feel like reading this you don't understand Alzheimers. Your brain slowly shrinks and shuts down.

My mom never went through vision or hearing issues but everything progressively got worse. So if your grandpa progresses like her this is going to happen again until it becomes normal for him to lose vision or hearing until it just doesn't come back.

I don't mean to be a Debbie downer, really. It is just by stage four we were used to things never coming back. :(

Events like that are apparently hard to diagnose. My Mother-in-Law keeps having these little 'events' that are almost like mini-strokes, but they haven't been able to diagnose her with anything. She's been told everything under the sun, including migraines. It's been years, still nothing.

At 86, and with stage 4 alzheimers, how far are you willing to go for answers? Sure, they could subject him to testing to try to find a diagnosis (or find nothing), but will that agitate him? Will he remember why he's there? Will the outcome change anything?

I know you want answers, but to what end? How far will you go for them? They (the hospital) should not make assumptions, I think they made the decision that an 86-year-old man wasn't worth their time. Jerks. :\

When my grandpa was in his 70s he ended up in the hospital. They couldn't figure out what was wrong with him (small county hospital). He continued to deteriorate and the hospital had no answers. Finally, his daughters decided to air ambulance him to Mayo Clinic--Rochester. It took them 3 days to figure out that he had French Polio (Guillain-Barre syndrome (GBS) is a group of autoimmune conditions consisting of demyelinating and acute axonal degenerating forms of disease. GBS is sometimes known as Landry's ascending paralysis, French polio, acute idiopathic polyneuritis, or acute idiopathic polyradiculoneuritis.) His symptoms were symptoms not usually seen or associated with Guillain-Barre Syndrome, so that was why the hospital staff hadn't been able to figure out what was wrong with him. Once they knew what he had, his symptoms cleared right up and he was released from the hospital a week later (and he lived for many, many years after that).

This article has some interesting info on GBS:
http://virtualmentor.ama-assn.org/2007/08/cprl1-0708.html

Sudden transient loss of vision and hearing should be investigated. It could be due to very high blood pressure, transient ischemic attacks or TIA, benign intracranial hypertension or even due to a brain tumor.

Here is an article that talks about sudden loss of vision, stating that it could be an eye stroke:
http://www.thompsoneye.com/visionloss.htm

Here is an article that talks about sudden hearing loss in the elderly:
http://www.intelihealth.com/IH/ihtIH/WSIHW000/9339/9418.html

From what little bit I was able to pull up online, it is conceiveable that an elderly person could have a mini stroke that would affect the eyes (seeing) and ears (hearing), although they are rare. I would definitely look into this possibility as well as the side effects of any pharma medications grandpa is taking (as many of the articles mentioned medication side effects as well).

And "old age" is NEVER an answer to a question. There is ALWAYS an underlying reason or a cause for something.

As I suspect you know, no one on this site can diagnose your grandpa. Even if this site were made of no one but doctors, we still couldn't dx him because we haven't examined him.

That said, my recommendation would be to schedule an appt. with a gerontologist and request a more thorough brain scan. It's possible (I don't know HOW possible) that he may have a brain mass that's affecting the functioning of his optic nerve.

I agree w/ JO...Stage 4 Alzheimers is pretty far "gone". He sounds far more coherent than my grandfather who has was at early stage for about a year ago.

My grandfather makes stuff up...when he's "there". Sorry but it could totally be him making stuff up. I can sit and talk to my grandpa until my face is blue in the face and he would have no idea I'm there.

Maybe try an Alz group...someone may have had this happen. But if his vitals were cleared then I'm sorry but it may have been in his head...Stage 4 can make a person zone out so much that maybe they think the worst.

Not sure.

I would take him to his regular doctor and have them run more tests.

My father was not feeling right. It's been too long and so I don't remember the exact symptoms. He went to the ER (ED) and they found nothing wrong. It happened again and his primary care doctor said it was likely a slow bleed in his brain. Our blood vessels get weak with age and it's apparently common for them to leak blood at times. There is nothing to be done to prevent it.

It is frustrating to be told it's because he's 86. Medical science just does not know all the answers. And.......our bodies are so complex that each of us can have symptoms not usually seen in others. I suggest that the doctor was trying to say, that you should expect unexplained things happening to someone this age.

I suggest that you talk with his primary care doctor if he's familiar with your grandfather's health. The ER is only prepared to deal with emergencies. They found him to be OK and sent him home. The emergency was over.

How scary! My grandfather was my hero. His mind was very much intact, but his body failed him from time to time.

I think you should follow up with your Gramp's regular physician. He or she should have any reports available from the ER. The Emergency Room is there to get people out of immediate danger.

Grandpa could have had low blood pressure, low sugar levels, low potassium levels. It's hard to say. They ruled out the two most serious things, heart attack and stroke. He wasn't in imminent danger and didn't require admission, thankfully.

Like I said, follow up with his regular doctor today. They should examine him to see if there are any changes in his BP, pulse, oxygen levels, etc. They can order more tests to find out what may have happened.

My grandmother lived to 94. She was tiny and often had episodes of being whoozy or short of breath. She had a home health nurse come once a week to take her vitals, give her a Vitamin B shot, and monitor.
As she got older, she became more anxious so they had her on a low dose of anxiety medication which also made her feel whoozy from time to time.

My point is, the regular physician can try to figure out what occurred and what caused it. The emergecy room isn't necessarily there to provide a diagnosis unless someone has a compound fracture, a heart attack, etc.
The regular physician can get the ER reports and go from there to try to obtain a diagnosis.

I know it's frustrating, but your grandfather's regular physician is the one who needs to either order more tests or translate the ER's findings and go from there.

I have worked at two hospitals. I've also been a patient myself.
The best thing to do is immediately follow up with the regular physician and go from there.

Very, very best wishes to you and your dear grandfather.

When you mentioned the vision and the hearing, I thought about his optic nerve in his eyes. Has he had them checked recently?? If not, maybe a opttometrist may have the answers. Since the hospital was no help, I would go to his primary care doctor and ask that they run a bunch of tests til you get the answers. Hope he is ok!

Sounds like an ER visit. They make sure your going to live (for now) and send you on your way. You have to go to your doctor to explain what happened and have him decide if further tests are required.

BTW my DD had an EKG once and it was like a 5 second test. Took longer to put the sensors on her than to run the test.

My first thought was a mini-stroke, but of course, I wouldn't really be able to say.

My only advice is to follow up with his doctor, and don't take 'he's 86' as a suitable answer. Regardless of his age, something happened to him, and the doctor needs to figure out what it was. And if the doctor doesn't know, then he needs to refer him to a neurologist or other specialist that might. Knowing is better than not knowing, in my book. Your grandpa needs you or another family member to be his advocate. Don't let him be overlooked!

I have a friend who is in her 80s that has a problem regulating the sodium in her blood - we get together on Saturdays, and more than once I ended up taking her to the ER for a sodium infusion. She had battled this problem for 7 years, and no one had an answer that went beyond 'you're getting older'. She is a sharp cookie, but people in medical settings always assume she is dumb or addled because of her age - it is very frustrating!!! Once they get to know her, though, and she fires back a few comebacks, they usually realize who they're dealing with.

The last time I took her in, I said to the doc "listen, she is in here way too often, and she feels miserable. There has to be some better way to treat this condition!" So they restarted some tests, and lo and behold, there was a new medication that wasn't available when her condition was first diagnosed...no one had ever thought about trying her out on it though. Now that she is on it, her sodium problems are gone, and she hasn't needed a trip to the ER or a sodium infusion in months.

So within reason, do what you can to make sure he is getting the best care possible. Your love for your grandpa is clear, and I'm sure he loves having you around. The best gift we can give the elderly folks in our lives is our time, attention, and real interest in their thoughts and life experiences. They are a treasure. I wish you all the best.

to me, it sounds like his blood pressure/blood sugar/potassium levels bottomed out - any or all of the above.

R.:

I understand your concerns. I would be upset too.

EEG's and EKG's are typically less than a minute. The EKG can stay on a while longer if they honestly believe that he's having a heart attack.

While I'm NOT a doctor, the symptoms sound like early-onset Alzheimers. If not that - then I would say a blood clot on the brain that dissolved itself.

He could have a NASTY sinus infection. I know that when I had a REALLY bad one? I felt like I had lost my hearing. My teeth even hurt it was that bad. Sinus infections, when the sinus cavities are inflamed and infected, will press on ALL parts of our head...brain, eyes, ears and throat.

Have your grand mother take him to his PCP and have another work up done. Then have her ask for a referral for an Alzheimers specialist and go from there....

GOOD LUCK!!! I'm sorry this is happening to your family!

R., here's what Stage 4 (out of 7 stages) Alzheimer's looks like:

Stage 4:
Moderate cognitive decline
(Mild or early-stage Alzheimer's disease)
At this point, a careful medical interview should be able to detect clear-cut symptoms in several areas: •Forgetfulness of recent events
•Impaired ability to perform challenging mental arithmetic — for example, counting backward from 100 by 7s
•Greater difficulty performing complex tasks, such as planning dinner for guests, paying bills or managing finances
•Forgetfulness about one's own personal history
•Becoming moody or withdrawn, especially in socially or mentally challenging situations

You have a lot ahead of you, to be very honest. Alzheimers can last over 10 years. It's very hard on your grandpa - he feels like pieces of the puzzle of his mind are falling out.

Quite frankly, I would think that he had a TIA. That's a mini-stroke. All they did was a brain scan, and that's not the only place that they need to check for a stroke. There can be a TIA in the eye, a clot in the neck artery, etc. Lots of times they don't bother doing a lot of testing in someone this old. (We had that problem with the hospital not wanting to test my grandmother.) They don't want to administer sedatives to unblock arteries for fear that the elderly person won't come out of the anesthesia, so they don't really bother to do the tests to see if there IS a blockage.

At some point, you will need to sit down with family and talk about if you will want to stop taking him to the ER. It's hard to think about that now, while he can still talk to you and reason and enjoy life. There will come a time when he is unable to do any of that. A DNR is what a lot of families end up having so that their loved one's lives aren't prolonged artificially when there are no more cognitive abilities. It's a hard subject, but as someone with a family member going through this, it's a reality we need to deal with.

For right now, hug him every day and enjoy what you have with him. Don't get frustrated when he can't remember. Just smile and remind him again, or don't bring up things that don't matter.

Hugs,
Dawn

It's frustrating I know but sometimes they just can't know for sure. I would have expected them to investigate a bit further especially considering the trouble he had breathing on the was there.

Hospitals and drs don't care or really take care of the elderly. They know if he dies no one will question it. He is 85. My grandmother died 3 yrs ago from a stroke. Prior to the stroke she drove was active she had more energy then any of us. I was the one who took her in for the stroke. I was with her and her speech changed and her mouth dropped she was confused. All the normal signs. When I got to the er her symptoms went away and she seemed fine. But I insisted they run tests. They did an mri said it was nothing but old age blah blah sent us home. Within hrs it happened again. Took her back insisted on a ct scan. Then they saw the stroke. I stayed with her everyday bc they never would even go in and move her or give her water. I actually flipped out once when I got to the hospital and found her naked in the bed. She was hot and tore off her gown and no one noticed. I said just because my grandmother is 86 does not mean I love her any less then when she was 56. I said she is a human being and should be treated as one. She wound up getting pnemonia and died. It was there fault. Pnemonia is common after a stroke and they never did a swallow test with her. Then waited too long to do a chest xray to treat the pnemonia. I can blame them all I want but bc of her age no one would listen. Its awful how some nurses treat the elderly

R.,
I agree with the others and recommend that you make an appointment with your grandpa's primary care physician. He will be able to spend more time with you and your grandpa and be more apt to investigate what is going on with him.

My disclaimer is: I am not qualified to diagnose, just some ideas that you can look into: The symptoms can be related to any number of things including TIA (mini stroke that quickly resolves, but sometimes is an indicator of a full blown stroke), migraine, brain mass and sometimes people with Alzheimer's can misinterpret their symptoms calling a headache a stomache etc...Also, urinary tract infections can cause strange symptoms in the elderly, mostly a change in mental status but you never know your grandpa may present atypical symptoms

It sounds like a scary experience and it is so frustrating to get treated with such disrespect at the ER. The symptoms that you describe are not just normal part of aging.

I would say mini stroke for definite.

A TIA?

That is sort of like a mini stroke -- a transient ischemic attack is when the arteries are temporarily clogged, causing symptoms. If they get irreversibly clogged it's a stroke.

I am surprised that diagnosis was not considered. I think that his diagnosis of Alzheimer's may have clouded the thinking of the medical staff thinking he was perhaps just another "crazy old man."

I would insist on a second opinion from a cardiologist and a stroke specialist.