The Morning Journal (Lorain, OH)

TIA might have occurred after fall

I had a small stroke in September. What probably brought it on was a fall backward downstairs in the dark. I hit the back of my head on the basement floor, which was carpeted, as were the stairs. I was stunned for a few minutes, but did not lose consciousn­ess.

Four weeks later while I was tilling my garden, my whole left arm and hand went numb. I couldn’t walk in a straight line. My speech was slurred, but my face was OK. I laid down, and the numbness went away after 20 or 30 minutes.

Now, two months later, it hasn’t recurred, and

I feel fine and haven’t had headaches. I’m 86 and in good health. I never saw a doctor about this. Do you think I should do anything special?

— J.H.H.

You have two concerning issues, which I am not sure are related. The first is the fall. Odds are, this is nothing to worry about, and without loss of consciousn­ess, many people don’t even alert their physician. However, at age 86, there is a significan­t risk of damage to the delicate blood vessels in the head.

A condition called subdural hematoma, involving bleeding below the dura mater (the protective connective tissue around the brain), may result. Very slow bleeding may continue into the subdural space until a person develops symptoms, which may resemble dementia, a stroke or a seizure. A CT scan of the head is recommende­d to check for bleeding.

The second is the episode you are calling a stroke, but what medical experts would call a transient ischemic attack (TIA). It’s similar to a stroke, except that its effects are not permanent and last less than 24 hours.

Because a TIA may herald a stroke with potentiall­y permanent and catastroph­ic effects, we take these very seriously and comprehens­ively review the person’s condition, looking for ways to reduce stroke risk, including blood pressure and sugar control if appropriat­e or medication.

I am not sure that your fall has anything to do with your symptoms of sensory loss and slurred speech.

A subdural hematoma can resemble a stroke, but I expect that the symptoms are permanent, at least until the pressure is relieved by draining the blood.

Neverthele­ss, the event that you had deserves urgent evaluation. Start with your regular doctor or a neurologis­t.

Contact Dr. Roach at ToYourGood­Health@med. cornell.edu.