Is There Any Equivalent to TIAs, RINDs, Prior to Hemorrhagic Stroke?

Question

Perhaps an aneurysm Pressing On a Structure?

Answer 1

The classic is the "warning leak" prior to SAH. That's why we have the "first or worst" rule with the evaluation of headaches: severe, sudden-onset headaches, even with negative CT, need further evaluation via LP. There are a lot of doctors who don't do it, and they get by OK, since SAH isn't that common, but all you need is to pick up one every few years to make the difference between a healthy young person and a spear of asparagus, and you'll be a believer.

Answer 2

Some are ischemic strokes first, with secondary hemorrhage. (especially if someone anticoagulates them after a TIA)

Those may have TIA's RINDs as with any other stroke.  The stroke the previous contributor was discussing is the hemorrhage from an aneurysm or AVM- The pre-bleed leak.  He is quite correct in saying the worst headache they ever had deserves a CT and an LP. Sometimes an aneurysm will blow into the brain tissue, causing Symptoms resembling an ischemic stroke. (they tend to be sicker, develop a stiff neck after 24 hours, more nausea.

Nowadays with a CT on every corner, it is easy to figure out the problem. Before the CT came along it was sometimes a bit of a challenge, and everyone got tapped if there was no evidence of increased intracranial pressure.

Answer 3

As far as symptoms yes there is a secondary cause of the symptoms specifically with regards to the face. Sudden numbness can be cause by inflammation of the nerves passing the eustachian tube from an inter ear infection. Many times when TIA's and RIND's are suspected and the is no clinical evidence from MRI or CAT scans the root cause can be tranced to the infection especially when elevated white cell count comes back in the blood workup. BUT most doctors don't test for infection when suspecting TIA's RIND's or stroke going directly to the most serious possibility first.

How do I know this. My wife kept experiencing facial numbness and dizzyness several years ago. The doctors kept saying it was TIA's and put her on medication for it.

After almost a year with continued episodes we were refered to another speicalist who concluded it was TIA's also. I got upset to say the least and demanded to see the head of the hospital as I had at that point spent several thousands of dollars on tests, scans, doctors and all the rest of it.  

After seeing the cheif of the department we had a little heart to heart as to my perceived incompetence of his staff. Needless to say he was not a happy camper when I finished with our conversation.  He sent us back to our GP with instructions to find the cause. period. We went back and the GP did a complete physical. After a year and 6 months when the GP got back the lab results and found the elevated white cell count he went looking for an infection. Found my wife had tenderness under her ear and sent her to an ENT who found she had an infection of the inter ear with complications of a broken ear drum and completely ocluded eustachian tube. It took about two months of treatment and a complete change in meds to clear up the infection and open the eustachian tube.

So there are other causes for the symptoms not just TIA's RIND's and micro strokes.