Asked by Melinda, Oklahoma
I have had episodes of blurriness in my right eye and vertigo with difficulty walking. I have had five of these episodes within the past six months and most only last 5-10 minutes. There is no pain involved, just right eye blurriness and trouble walking. The worst episode lasted 30 minutes and was accompanied with nausea and the vertigo and walking was extremely impaired. I am a 51-year-old female in good health.
Dr. Otis Brawley
Chief Medical Officer,
American Cancer Society
These symptoms merit an immediate visit to an emergency room. I encourage anyone with symptoms such as these to see a physician quickly. Indeed, anyone who has had these kinds of problems and not gotten medical evaluation should still go see a physician even if the symptoms have gone away.
The physician will listen to you describe your symptoms in detail, examine you, and get some laboratory blood studies. The physician will be very interested in questions about heart disease, especially rhythm problems such as atrial fibulation. A history of hypertension, cholesterol and triglyceride problems and diabetes is also very important.
The physician will create a differential diagnosis. This is a list of conditions that may be causing your symptoms. Once that list is created, a workup plan of further testing is created.
Without benefit of the above information, I will say I worry that you may be having transient ischemic attacks. These are commonly called TIAs or mini-strokes. It is an episode of focal neurologic dysfunction caused by decreased blood flow to an area of the brain, spinal cord, or retina. In a TIA, the episode abates without permanent injury usually in less than 24 hours and some times lasts only minutes. TIAs differ from strokes, in that a stroke involves permanent death of a part of nerve tissue.
The blurriness can be due to temporary blockage of blood flow to the area of the brain that processes vision from the right eye or to the retina on the right. Similarly, difficulty walking, dizziness and nausea can be due to decreased blood flow to specific areas of the brain.
TIAs are caused by structural blockage of a blood vessel. This is most commonly due to atherosclerosis or certain types of inflammation of blood vessels. Partial blockages can sometimes cause blood clots. These clots can dissipate before permanent damage is done. Other causes of decreased blood flow involve increased blood thickness.
The high blood sugar of out-of-control diabetes can cause the blood to be syrupy and not able to flow into small arteries. Rarely this phenomenon is seen in patients with blood diseases such as a condition called polycythemia vera, or chronic leukemias.
A TIA needs to be diagnosed early. It can often be treated to prevent it from evolving into a stroke and permanent neurologic damage. Patients with a history of TIAs should be followed carefully by a skilled physician as they have a higher risk of cardiovascular events such as heart attack and stroke. This risk can be reduced with aggressive therapy. Most will be treated medically, but some may need surgery to clear the carotid arteries of cholesterol plaque or repair other blood vessels.
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