Neurologist 2017-06-30T15:45:43+00:00

Professor Pankaj Sharma – Neurologist

Questions submitted by younger stroke survivors and answered in the Different Strokes newsletter by Professor Pankaj Sharma, Neurologist and Stroke Expert.

Please note that while our panel endeavours to give the best advice based on info provided, it is always advisable to have a face-to-face consultation with a practitioner about any health issue that concerns you.

Comments expressed are general in nature and are not intended to provide specific advice.

If you would like to submit a question to be answered by one of our experts, please email experts@differentstrokes.co.uk or write to Different Strokes, 9 Canon Harnett Court, Wolverton Mill, Milton Keynes MK12 5NF.

You may also like to read our Frequently Asked Questions About Stroke (link to this section in Helping Each Other) to see what other younger stroke survivors are saying.

Cold Weather

Question:

“I had a stroke 9 years ago aged 34 years. The cause was a blocked Vertebral Artery on my left side, which caused a Brain Stem infarction.

Since then I have recovered the use of my arm and leg to a fair degree. I walk with a limp and have some use of my right arm and hand. All is manageable until the weather gets colder. My walking deteriorates and I stumble along, my arm contracts and I have the classic look of a stroke survivor. It makes me very self-conscious and I feel vulnerable.

Why does the cold weather have such an adverse effect on my movements and can anything be done about it?”

Answer:

Thank you for your question. I am sorry to hear that you suffered a stroke affecting the brainstem but pleased to discover that you are making good progress.

Your question about temperature is an interesting one. Cold weather has a number of effects on stroke. For example, it is known that the incidence of stroke is greater during the winter months compared to the summer season. A 5°C temperature drop can result in a 7% increase the number of stroke admissions. There are likely to be a variety of reasons for this increase in incidence, including virus exposure.

However, your specific question regarding your reduced mobility in cold weather is most probably related to the increase in muscle tension during drops in temperature. Most of us are affected by this but in an already damaged body the effects tend to be more pronounced.

I’m afraid there is no specific treatment except to look forward to the improvements in movement that should result during the spring and summer months. Of course if you are able to spend the winter time abroad in regions with warmer temperatures that will also help.


Epilepsy

Question:
“My husband recently had an epileptic fit after his stroke. It came completely out of the blue and was very frightening for both of us. Please could you provide more information for us about why epilepsy can occur after stroke and what we can expect for the future. Thanks.”

Answer:

I am sorry to hear about your husband’s stroke. An epileptic fit can occur at the same time as the stroke or at a time in the future following a stroke. From your question I assume the fit took place after he had settled from his sudden stroke.

The reason this occurs is because of damage to the brain cells from the stroke. The surrounding brain cells can become over active as a result of residing next to the damaged ones. It is this over activity that, if too great, can spread suddenly across the brain resulting in a fit. Fits can recur but the good news is that patients respond well to anti-epileptic medicine and if you have not seen your doctor about this you should do so.

There are several restrictions that apply following a fit such as driving, sports etc. which again your doctor should be able to advise you on.


Migraines

Question:
“My Neurologist says I have had some TIAs but not a stroke, and that these TIAs have been caused by migraines. I wondered if you could provide any further information about the link between stroke and migraine. Thanks.”

Answer:

I am sorry to hear about your TIAs (mini-strokes) which your neurologist says are occurring as a result of migraine. There is a growing body of evidence linking migraine with stroke. The majority of the studies seem to suggest the risk is increased with those who suffer from ‘migraine with aura’, i.e. patients who have some warning signs prior to headaches. Such warning signs are typically observed as flashing lights which can precede the onset of the headache by about 30 minutes. These type of migraine sufferers tend to have an approximately doubling of risk of stroke with the highest risk in females under 45 years of age and those who use the oral contraceptive pill.

It should be emphasised however that although an increased risk is observed in these patients the actual risk of stroke remains very, very low. If however, you fall into any of these categories it may be worth taking some precautions such as avoiding the contraceptive pill. You should speak to your GP about this.


Paraesthesia

Question:
“Can you explain more about the causes of paraesthesia and how the symptoms can be alleviated?”

Answer:

Thank you for your question.  A stroke is a condition that damages parts of the brain. If part of the brain that is responsible for touch sensation is affected then the ability of the body to correctly handle such information is reduced.

Paraesthesia refers to the sensation of touch which is handled by a specific part of the brain. Abnormal paraesthesia following a stroke is a very common complaint. Often the symptoms are mild and reduce over time, eventually disappearing.
However, if you find the symptoms particularly disturbing then there are a variety of medicines that can be prescribed to reduce these symptoms. Those tablets need to be taken regularly and daily for several months and occasionally 1-2 years.

Your GP will be aware of the types of medication and should be able to prescribe them. They are not available over the counter without a prescription.


Pontine Stroke

Question:
“I had a pontine stroke 8 years ago. Thankfully I survived and most of the permanent side effects it left can be coped with.  Except the bodyclock problem which runs me and my life.

Given my completely irrational hours and random sleep/awake patterns, I believe my pineal gland has been damaged by my stroke. Thus it releases chemicals at the wrong time, or in the wrong quantities, or both at the same time, or not at all. This is the only explanation I can advance for the bizarre hours that make up my daily routine now.

I would like to discover if there is any expert medical opinion available to support or discount my theory.”

Answer:

I am sorry to hear about your stroke and pleased to hear that you seem to be adjusting to it, but I appreciate how difficult it must be. In terms of a change of sleep/wake pattern following stroke this is not that uncommon. It is unlikely to be due to damage to your pineal gland, although I obviously do not know your medical history.

It is not quite clear why stroke patients can get changes in their sleep/wake pattern. These patterns often will improve spontaneously over time. Going to sleep earlier and not drinking stimulants such as coffee late in the evening may also help. In some cases a sleeping tablet at night may be helpful to ‘reset’ your body clock but clearly this needs to be discussed with your doctor.”


Post Stroke Pain

Question:
“I have just started taking 300gm of Gabapentin for post stroke pain. How long does this take to help this terrible pain and do the side effects settle over time?”

Answer:

Thank you for your question. I am very sorry to hear about your pain. This is not an uncommon finding after stroke and some people can find it quite debilitating. Fortunately that severity of pain is not frequent.

Gabapentin is often prescribed and can be very effective, although the dose and frequency of the tablet may need to be increased over the course of a few weeks and months. The pain will settle eventually in time, although the exact length of time is difficult to predict. However, if you are finding that Gabapentin is not helping then there are several additional or alternative medicines that can also be prescribed. I would suggest you see your GP to discuss this further.


Sore Tongue

Question:
“I had a stroke in 2003 which was an Aneurysm/bleed at the back of the head. I survived but with the traditional weaknesses. One of these is a sore tongue. This affects everything, eating, sleeping, speech and more. Have you heard of this complaint, or even better, can you advise me what to do, or if I can do anything about it?

The pain is like a grazed knee on the tongue and roof of the mouth. When I feel low it gets on top of me and I obviously could do without it. My GP can’t see anything, and neither can Guy’s hospital who have only advised pain killers. They have likened it to an amputee who can still feel his fingers even though they are not there. A hot mouth syndrome has been ruled out, however it did start as ulcers on the tip of the tongue which manifested into sores on the advice of a herbalist who told me to avoid coffee and tomatoes. The change indicated to me that the condition could be manipulated which is why I am seeking expert advice.

I’ve had this condition for nearly eight years and it hasn’t got any better or worse. Please, please, please can you advise me!”

Answer:

Thank you for your question. I am sorry you are having such problems. A stroke can cause all sorts of unusual symptoms apart from the well recognised weakness down one side of the body. Patients with a certain type of stroke can complain of unusual types of painful sensory symptoms.

However, your stroke was in the ‘back of the head’ and this would not be a typical place for such sensory symptoms. Notwithstanding the location of your stroke, if the symptoms are due to it then there are drugs which can help.  They tend to be derived from the anti-epilepsy class of drugs and one of the commonest ones is Gabapentin.

Another possibility to consider is whether the ulcers in your mouth are in any way related to the cause of your stroke. There is a rare condition where the two symptoms can occur together and it is called Behcet’s disease.

However, I do wonder whether your symptoms are stroke related at all. There are many other causes of a sore tongue and they include metabolic abnormalities and nutritional deficiencies (e.g. vitamins etc). If your GP is unable to get to the bottom of your problems may I suggest you ask for a referral to the Ear Nose and Throat (ENT) consultant at your local hospital.


Stem Cell Therapy

Question:

“I have heard a lot about stem cell therapy in the press recently.  I would like to know more about the timescale of when you think it will be available as a treatment for stroke, and how I can go about volunteering for research trials.”

Answer:

Thank you for your interesting question. Stem cell treatment involves delivering cells to an affected organ in the anticipation that those stem cells will replace the diseased cells within that organ.  Stem cells by definition are able to become other cells depending on the appropriate stimulus. This is the principle of stem cell treatment at its most basic level.

There is much interest in this subject and we at Imperial College London are conducting, to the best of our knowledge, one of the very few stroke stem cell trials in the world. However, that excitement must be tempered by the fact that these trials are in the very early stages of development – designed to address, at least initially, questions on safety and tolerability rather than effectiveness. It follows therefore for this technology to enter general clinical use is likely to take at least a decade at best, and a generation, at worst. While this is an exciting area to be involved in it is unlikely to benefit current stroke sufferers. Notwithstanding this reservation, it is important that we continue to ‘reach for the skies’ for the benefit of future generations.


Stroke in Thalamus

Question:
“In January I suffered a stroke in my Thalamus.  Following an MRA scan of my neck, my vertebral artery was found to be “thready” and fragile looking with signs of dissection, therefore the probable cause of my stroke.

I don’t have any motor deficit at all but am suffering overwhelming fatigue and memory-gaps, particularly the names of people I have known for quite a long time and general knowledge questions that I am sure I knew before.

My questions are:

  • How common is this type of stroke?
  • My GP has commenced me on Aspirin 75mgs and Simvistatin 40mgs.  My Cholesterol level was 5.7. Is this the appropriate treatment or should more be done to prevent a further stroke?
  • Will my memory return to normal or am I likely to suffer this loss permanently?
  • Also I am a road cyclist, which I do to keep fit, am I putting myself at risk by following this hobby? Thanks.”

Answer:

Thank you for your question and I am sorry you have suffered a stroke. The cause for your stroke seems to be a vertebral artery dissection which essentially is a rip in the lining of one of the arteries that supplies blood to the brain. The cause for this rip would have no doubt have been investigated by your doctors, although it should be said that a cause is often not found. Dissections are frequently seen by stroke physicians but are not as common as ‘usual’ strokes.

Fatigue is a very common complaint following any stroke. However, the area of the brain that has been affected in you is involved in memory and may explain your memory gaps. These symptoms are likely to improve as time goes on but the exact level of improvement is of course difficult to predict.

Your cholesterol level does seem to be high but it is not clear whether this level was taken after starting simvastatin. If the level does not drop to around 4mM/l then I would approach your GP for alternative and more powerful drugs.

Undertaking exercise like cycling is an excellent idea and to be encouraged. It is unwise to cycle soon after a stroke but if your memory has improved enough to allow you to cycle and your physical condition does not impair your cycling, then you should go out cycling and enjoy yourself!


Stroke Recurrence

Question:
“In Sept 2011 I had a TIA, my left side went numb overnight. I was admitted to hospital and went home the next day. I felt weak for a couple of weeks but recovered well.

Then one fateful night in November 2011 I had a full stroke. I was confused, couldn’t move my left side and was very weak. I spent 5 nights in hospital where they regained my walking ability to a point where I could go home. Since then I have had the neuro rehab team coming regularly but am still weak on my left side, being sick, don’t eat properly and VERY tired.

I have had a CT scan, MRI scan and a heart echo, all 3 of which were normal. This is my confusion. I am glad they were normal but reading up on strokes, it all seems that a stroke is detected from a scan. The consultant said I definitely had a stroke and it was down to high blood pressure, diabetes and strong family history. I am pleased all is clear but I am just worried it is going to happen again.”

Answer:

Thank you for your question. I am sorry you have had a complete stroke following your mini-stroke (TIA). You say you are very tired following your stroke. It is not at all clear why tiredness occurs after a stroke but it is a very common problem. You do not say how old you are but many people under- estimate the degree of tiredness they will experience once they return to work. You should not over-exert yourself and be prepared to work for shorter periods of time. The tiredness will improve eventually, but can take some time.

You are worried about a recurrence of your stroke. This is obviously something almost everyone worries about. The facts are that the chance of recurrence is usually highest in the first month and then falls over the next year or so. The risk remains slightly higher compared to the general population for some years thereafter but you will have been given tablets such as aspirin and statins (anti-cholesterol) as well as possibly anti-blood pressure medications. All of these tablets will significantly reduce your chance of future strokes. You must make sure however, that the tablets are effectively controlling your blood pressure and cholesterol levels via regular checks with your GP.


Stroke Recurrence

Question:
“Is it more likely for a person to suffer further strokes after having one? What is the likelihood? I had an Ischemic stroke 2 years ago. I had stopped smoking 3 years prior to having the stroke and I was not overweight. I have not drunk alcohol since I was approximately 22 years of age.

I am now 54 years old. My father had a slight stroke when around 50 years of age, but no other close family members have suffered one. I am now taking aspirin and cholesterol tablets. I have a visual field problem, my balance is affected and my memory is poor.”

Answer:

I am sorry to hear about your stroke. I’m delighted to hear that you stopped smoking (even though it was before your stroke) and by doing so you have considerably reduced your chances of a vascular disease affecting your heart, brain or other organ (not to mention risk of cancer).

Anyone that has had a stroke is at a higher risk of having further strokes. That risk is greatest in the first month and reduces thereafter but continues to be slightly higher compared to the general population. The fact that there is a family history of stroke may also increase slightly the chance of a stroke.

However, much more important is the fact that you take aspirin and anti-cholesterol tablets. Each of these measures reduces your chances of a stroke by around 25%. Maintaining a good BP is also critically important to reducing your chances of being at risk and your GP can advise you on taking antihypertensive medication (even if you do not suffer from high BP).


TIAs

Question:
“My Neurologist says I have had some TIAs but not a stroke, and that these TIAs have been caused by migraines. I wondered if you could provide any further information about the link between stroke and migraine. Thanks.”

Answer:

I am sorry to hear about your TIAs (mini-strokes) which your neurologist says are occurring as a result of migraine. There is a growing body of evidence linking migraine with stroke. The majority of the studies seem to suggest the risk is increased with those who suffer from ‘migraine with aura’, i.e. patients who have some warning signs prior to headaches. Such warning signs are typically observed as flashing lights which can precede the onset of the headache by about 30 minutes. These type of migraine sufferers tend to have an approximately doubling of risk of stroke with the highest risk in females under 45 years of age and those who use the oral contraceptive pill.

It should be emphasised however that although an increased risk is observed in these patients the actual risk of stroke remains very, very low. If however, you fall into any of these categories it may be worth taking some precautions such as avoiding the contraceptive pill. You should speak to your GP about this.