h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

I understood an ultrasound wouold also show any damage to the carotid artery which can occur in sports or accidents.

I'd also add don't be fobbed off, my daughter recently suffered an stroke and was sent away from hospital with it diagnosed as a migraine. So stand your ground, you are the best judge of something being wrong with your body.

Page turner

Entry: Transient Ischeamic Attacks - or Mini Strokes - A62961366
Author: Dr Zen - U185843

I've just discovered this in a bored moment.

Having now read it, I can't add anything. This really is something that people should know more about.

However, I do have a question.

I did once have something like this, but I think it was more connected with migraine. But: I am not generally a migraine sufferer, and I had no headache following the "attack". Symptoms: pins and needles in left arm and leg, zigzags in front of my eyes (otherwise unimpaired vision) and momentary disorientation. I was on the phone at the office and was trying to dictate a phone number to someone. Was incapable of doing that - couldn't get the numbers out, as is described in the entry - although I managed to put the call through to a colleague and explain what I was trying to do and why I couldn't do it.

Could you expand more on the differences between the type of stroke caused by a blood clot and a pre-migraine attack? Is there even a connection between the two? It doesn't sound like there is, but the symptoms are so similar, it made me wonder.

All the little typos, extra words and apostrophes can be sorted out by the sub-ed, as they are very straightforward. Dr Z has done the work - we all know what he means at all points in the entry.

However, perhaps if you read it through yourself again, now a few days have elapsed, you would find those few tiny mistakes of expression and can iron them out, to make easier reading for anyone else who reviews it.

I'll see if I get a chance to re-read it tonight! I don't seem to have as much spare time as I used to.

I think I've made all the changes. I've uncaptialised the drug names. My secretary always capitalises them in my letters, and I always prescribe in capitals but that's obviously just a medical convention.

Let me know if there's anything else.



Z

I think this is looking good to go.


*ties string across door to pr to trip up a scout.*

Would you include personal experiences if anyone on hootoo had any?

e.g., as in A533161 or A24833270

Makes the problem more "real". Only if you want to, though - the descriptions are very easy to understand and relate to as it is. It's hard to believe you're a doctor, they're so accessible!

*ducks *

I'd love to include personal experiences, but when I put a request on ask no one came forward. I'm glad you think it's accessible

Any other ideas?

Very interesting entry, Zen, well done. I haven't read the PR thread, so excuse me if this has been mentioned: my dad was once diagnosed to having had such an attack (he never realised it), and he had to take aspirin to make the bllod thin afterwards. I don't recall for how long, though.

We usually recommend Apsirin 75mg for the rest of your life if you can tolerate it, for the first two years we also recommend Dipyridamole 200mg (twice a day) as well.

Sorry about the big list, Dr Zen. It's not as bad as it looks, I promise! I think this is a cracking entry and no offence if I say I hope it is of no use to anyone! Unfortunately (in a way) I think it may be.

Here are my suggestions. As ever, up to you what, if anything, you change.


"You know what you want to say but the words just won't come out. No words, at all. It's quite common that you can think of something but aren't able to find the word, but this time it's different, whatever object you think of you can't think of the word. When ever you want to talk you know what to say, but nothing comes out."

Is it just me, or does this say 'you have the words but can't say them', then 'you don't have the words at all' then 'you have the words but can't say them' again?



"This isn't a stroke, because the damage isn't permanent, it's a 'Mini Stroke', doctors' call this a 'Transient Ischaemic Attack' or TIA" Full stop needed.



"Attack - because it's an attack" - there's nothing wrong with this at all, but if you wanted to you could make the tone a little lighter after that powerful introduction by changing this to something like: "Attack - because it's not friendly, is it?"



"A TIA might cause a weakness of an arm or leg, or both. If it affects 2 limbs then it's probably going to affect the arm and leg on the same side, rather than both arms or both legs."

Or the right arm and left leg, or vice versa. No need to include that though.



"If your symptoms have resolved by the time you see the doctor then she may be able to make a diagnosis of a TIA, if that's the case she will be able to start treatment with aspirin right away"

Not a suggestion, I just like 'she' being used as the general pronoun. I suppose that is the case in medicine, isn't it?



"The specialist will be able to decide if you have had a TIA and do some tests to check that there are no other causes. Then they will do everything they can to stop you having a stroke."

Does that mean that if you have had a TIA you are more likely to have a stroke in future? If so, could you talk about that in the entry a little?



"There are a number of factors that increase the risk of a serious stroke "

Full stop needed. Also, I'm not sure why you're talking about serious strokes when the entry is about TIAs.



Footnote 2 needs to be punctuated.



"A brain scan2 is usually normal in a TIA - because the clot has not caused any lasting damage to the brain."

Is there a 'not' missing? Otherwise, why would you do a brain scan if there is no damage?



" 1. Treatment to stop the blood clotting This can be aspirin or other tablets that act against the platelets in the blood. People with atrial fibrillation often need warfarin, which is a more powerful way of stopping the blood clotting.
2. Reduction of risk factors Stopping smoking, making sure your blood pressure and cholesterol are both well controlled. Diabetics need to make sure there blood sugar is well controlled."

Purely a style thing, but my inclination would be to do these as a bulleted list rather than a numbered list. I also think you need a hyphen or something between the bold header bits and the content.

1. With expressive dysphagia you have the concepts but can't find the words - I've amended the first paragraph to reflect this.

2. Full stop added

3. Change about the wording after attack made

4. I've left the description of arms and legs the way it is..

5. I thought I'd mentioned in 2 different places that the reason TIAs are important is because they increase the risk of a stroke. I've re-inforced that now.



6 "A brain scan2 is usually normal in a TIA - because the clot has not caused any lasting damage to the brain."

Is there a 'not' missing? Otherwise, why would you do a brain scan if there is no damage?

You do a brain scan to check the symptoms aren't caused by a bleed or a brain tumour. Again entry amended to reflect this.

And now I *have* to leave for work! But will be back later.. and will review the changes to check it's clear.

How do you know the difference between a TIA and a stroke? Is there a definition?

Is there a difference between the treatment of each?

Does a TIA bring on other symptoms, like the inability to swallow, or is that only from a stroke?

A TIA is a stroke that gets better within 24 hours.

Some strokes can be treated with thrombolysis (a drug to break down blood clots), but that isn't available at all hospitals. Otherwise treatment is similar.

You can get swallowing problems from a TIA but you wouldn't notice unless you were eating at the time.

Another difference is that with a stroke usually you have to stay in hospital, but manly TIAs can be managed as outpatients.

Righty-o is there anything else I need to do here?

Looks good to go I reckon.