TIA or whatever

Over on Language Log, Mark Liberman reported on (in a posting entitled “Heavy burtation”)

one of the most widely discussed aspects of the Grammy Awards ceremony … the painful-to-watch on-camera aphasic episode of Serene Branson, a reporter for CBS news

It’s distressing indeed, and some of the responses to the story are even more distressing, amounting to infantile mockery of the sort directed at crips and retards. (Even on Language Log. The LLoggers have now spent some time deleting the worst of the dreck, though this means checking the comments every few hours.)

It’s not clear what the ultimate cause of Branson’s on-camera aphasic episode might have been, but it certainly looks like the immediate cause is a disturbance in blood flow to parts of the brain, which itself could result from any number of sources: a mini-stroke (either ischemic or hemorrhagic) or other insult producing temporary aphasia, or (very likely) some event leading to a transient ischemic attack (TIA) with temporary aphasia as one of its symptoms. These things can be very hard to diagnose, and the symptoms will be different depending on where in the brain the blood flow is disturbed.

I’ve had some experience with TIAs, through my partner Jacques’s experiences with them. Here’s an account (posted on the newsgroup soc.motss on August 26, 1993) of an event that sent him to the ER in Columbus OH:

On Tuesday Jacques had three, increasingly serious, TIAs (transient ischemic attacks; they look like little strokes, but they pass away).

In event #1, in the morning, J lost the peripheral vision in his right eye. No other symptoms, and he felt fine. There was just this unevenly shaped hole in his vision. By the time he was on the phone trying to get through to the ophthalmologist he saw in june, his vision returned, and he abandoned the quest.

Event #2 happened while we were out for lunch. It took him over three minutes — this is really quite a long time — to figure out how to unfasten the seat belt and to do it. He was then completely befuddled for another ten minutes — clearly didn’t understand where he was, or what people were saying to him. He just smiled the sweet smile he uses when he hasn’t a clue about what’s going on. Then he came back to normal, completely, ordered and ate lunch happily, though it was clear to him that I was distressed.

I said it was time to see the neurologist. He said no, that these weren’t neurological problems at all, probably just the result of the heat and his discomfort at the sound of the fans running at night. I said that they were textbook neurological problems, characteristic of small stroke-like events. I explained strokes. He refused to credit my accounts. He napped a bit, felt fine, and insisted I go off on my run to the university (to check mail, etc.).

When I got back he was well into event #3. Broca-style aphasia, right in our own living room. He stammered helplessly for words. When he got them, all the content words were wrong (and this was clear to him); he repeatedly said we needed to do something about “the cancer break”, each time realizing that this wasn’t what he meant to say. Then he shifted to circumlocutions without content words, for instance “the one that wasn’t able to do the thing”; this satisfied him, but he was then irritated that I didn’t understand what he’d said.

Eventually I figured out that he’d made two telephone calls to doctors while I was away, and wasted some time trying to track down which ones they were, in the hope that he’d already contacted someone useful. (It turned out that they were calls about bills, to doctors not at all connected to yesterday’s problems.) This did get me in touch with the neurologist, though, and he said (through his nurse, of course) that I should get J to the emergency room at Riverside Hospital, immediately.

J didn’t really understand why we were going out in the car, but he did what I said, to be amiable. His speech started to improve on the drive; not many content words, but more fluency. He had no idea who Jim Barnes (his neurologist) was, or what Riverside was, so we were scarcely out of the woods yet.

He was still pretty incompetent during registration at the ER (and apparently impressed the staff with his symptoms), but by the time his ER nurse turned up he was almost back to normal.

Then we had the ol’ six hours in the ER. They did a CT scan, which was read by a great many people. No obvious signs of bleeding or swelling, but as we moved higher up in the ranks of MDs, worries increased. The attending neurologist couldn’t fully interpret part of the scan, because of the way bone had been removed from J’s skull in the 1980 cancer operation. He called in the chief neurological resident, who suspected that what they were seeing was not bone bits, but some bleeding. They scheduled MRIs for wednesday morning.

So…eventually to the neuro ICU, where he was (unhappily) attached to a lot of wires and IV tubes and allowed to eat nothing but ice chips. He was still disinclined to credit these theories everyone seemed to have about his suffering from neurological problems, although the fact that he developed a nagging headache, one only at the back left side of his head, made him think that there might be something in these ideas after all.

I kissed him goodbye around 10:30 Tuesday night, at which point there’d been no new events for over six hours (the doctors were concerned about the “crescendo” effect in the three episodes) and he seemed just fine, except of course for the unpleasantness of being in an ICU, hooked up to all those tubes and monitor wires.

Yesterday they did those MRIs — many, many of them — and eventually read them and saw that they were beautiful. And moved Jacques out of the ICU and into an ordinary room, sans all those wires and tubes.

Last night another neurologist appeared and took a history, mostly from me (since J now remembers very little of what happened), and did lots of on-the-spot tests. Eventually he opined that, unless some pretty unlikely things turned up from other tests (carotid artery flow, blood work), what had happened was almost surely the result of the intense radiation therapy J had in 1980; the radiation fried the little blood vessels a bit, and now they’ve been thickening and therefore slowing the blood flow here and there in the left back part of J’s brain. The heat probably contributed to Tuesday’s events, since it too slows blood flow.

In fact, yesterday’s neurologist thinks the radiation is probably responsible for most of the other symptoms of the past year and a half, too. He thinks the radiation also fried an assortment of nerves a bit, and that damage to them is what has produced this peculiarly selective pattern of left-side facial muscle weakness (plus lesser weakness in J’s left arm and leg).

Meanwhile, J is now taking a baby aspirin a day to thin his blood and stave off further TIAs.

And they sent him home a couple of hours ago. We are holed up in the airconditioned bedroom; the rest of the world is indescribably uncomfortable, and probably dangerous for him. He is sleeping off two days in the hospital. I’m telling you this story.

The heat is an important part of the story, as it was in the story of J’s first TIA — well, the first one anyone observed — on May 19, 1991, during a Bay to Breakers that J and I walked in San Francisco, on an unusually hot day, where the heat, the exertion, and his reluctance to drink water combined to make him dehydrated. Add that to the slowing of blood flow due to radiation damage, and you’ve got a set-up for a TIA.

The last neurologist in 1993 in fact told me that TIAs were not uncommon in marathon runners, who would end up crossing the finish line temporarily aphasic (usually with a halting Broca’s-like rather than Branson’s fluent Wernicke’s-like affliction, but still).

 

One Response to “TIA or whatever”

  1. Bay to Breakers 1991 « Arnold Zwicky's Blog Says:

    […] in my posting on TIAs (transient ischemic attacks), I gave the story of J’s first TIA — well, the first one anyone […]

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