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28 November 2018

Helen was convinced she had a cold but her symptoms suggested something more

Her sister had come with her to surgery. We exchanged a glance.

By Phil Whitaker

Sixty-three-year-old Helen was inclined to put everything down to a cold.

“I was lying on the sofa when I came over awfully dizzy,” she explained to me. “But you get that with colds sometimes, don’t you?”

I agreed. A viral infection of the inner ear is probably the commonest cause of acute vertigo that we encounter. And it was definitely true vertigo that Helen had experienced; it had felt as though the room was spinning around her, so violently as to make her sick. But even though she’d had a recent cold, I wasn’t convinced this was the source of her problems. Vertigo from a viral infection will persist for days and hers had resolved within two hours.

“Was there anything else?” I asked. “Such as trouble with your vision?”

Now I came to mention it, she had noticed the picture on the TV being very blurred at the time, so much so that she couldn’t really make it out.

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“And what about your hearing? Any ringing in your ears, or deafness?”

No, there hadn’t been any tinnitus. But in fact, that was why she’d gone to lie down: her elderly mother had been visiting, and she’d suddenly found herself unable to make out what she was saying. “But you get that with colds, don’t you?” she said. “Blocked ears?”

“And that’s better too, is it?”

“Yes. Perfectly.”

Helen’s voice had a note of defiant impatience: this was all a lot of fuss about nothing, and she just wanted to get back home to her visitors. Her sister had come with her to surgery. We exchanged a glance. Her expression spoke volumes: she’d seen how Helen had been, and I could tell she wasn’t buying the “it’s-just-a-cold” theory either.

I checked Helen over. She’d had a foot operation the week before, but there was no sign of any complication from surgery. Her blood pressure was up slightly, but other than that there was nothing to be found.

I folded my stethoscope and put it back in my bag. “Listen,” I said, “I don’t want to alarm you, but I’m pretty sure what happened was something called a mini-stroke.”

I explained about transient ischaemic attacks (TIA). How a vessel taking blood to a certain part of the brain becomes blocked, usually by a clot, but this subsequently clears and the oxygen supply is resumed before permanent damage is sustained.

Helen was disbelieving. She was well-versed in the classic stroke signs – difficulty speaking, weakness in an arm and/or leg, drooping of one side of the face. Surely she would have had those? I gave her a brief account of the brain’s blood supply: how the majority of strokes occur in territory supplied by the anterior circulation, which contains the regions involved with speech and motor control. But I suspected her TIA had been a less usual type affecting the posterior circulation, which can create problems such as vertigo, double-vision and, on occasions, acute hearing loss.

I started her on aspirin: there’s a significant risk of developing a full-blown stroke after a TIA, and blood-thinning medication prevents around 80 per cent of these attacks. Given the stroke risk, there’s a dedicated clinic to ensure prompt assessment. Helen was seen in hospital the following day and put through a full work-up. The consultant confirmed diagnosis.

I followed up a few days later. Helen’s family had gone so she was back on her own. Prevented from driving for a month, she’d been dwelling on events. Why had it happened?

Her unsuspected high blood pressure had been a factor, I explained, but the timing might have been due to her foot operation. In the weeks following surgery, tissue repair provokes changes in blood chemistry that make it more likely to form a clot. The risks aren’t large, but there’s a definite excess of strokes and TIAs in the post-op period.

She gave me a long look, digesting my comments. “So, nothing to do with the cold?”

“No,” I said. “Nothing to do with the cold.” 

“Chicken Unga Fever”, a collection of Phil’s Health Matters columns, is published by Salt

This article appears in the 28 Nov 2018 issue of the New Statesman, How the Brexit fantasy died