Coeliac Disease and Ischemic Stroke
I’m up early and playing on the Internet with Google. I’ve just typed “stroke coeliac” into the search engine with a couple of modifiers to cut out some of the things I already know about.
I have now found this paper by El Moutawakil B, Chourkani N, Sibai M, Moutaouakil F, Rafai M, Bourezgui M and Slassi I working in Casablanca in Morocco, entitled Coeliac Disease and Ischemic Stroke. This is the extract.
INTRODUCTION: Neurological manifestations of celiac disease are various. An association with ischemic stroke is not common and has not been well documented. We report two cases.
OBSERVATIONS: The first patient had experienced several transient ischemic strokes in the past 2 years and then had an acute ischemic stroke involving the territory of the right posterior cerebral artery. Investigations revealed celiac disease with no other recognizable etiology. The clinical course was marked by persistent visual aftereffects, but no new vascular event. The second patient had been followed since 1998 for celiac disease confirmed by pathology and serology tests. She was on a gluten-free diet. The patient had an ischemic stroke involving the territory of the left middle cerebral artery. Apart from a positive serology for celiac disease and iron deficiency anemia, the etiological work-up was negative.
DISCUSSION: The mechanisms of vascular involvement in celiac disease are controversial. The most widely incriminated factor is autoimmune central nervous system vasculitis, in which tissue transglutaminase, the main auto-antigen contributing to maintaining the integrity of endothelium tissue, plays a major role. Other mechanisms are still debated, mainly vitamin deficiency.
CONCLUSION: Being a potentially treatable cause of ischemic stroke, celiac disease must be considered as a potential etiology of stroke of unknown cause, particularly in young patients, and even without gastrointestinal manifestations.
I’d always fancied going to Casablanca to see the ghost of Humphrey Bogart.
Beware the Ides of March
I had my stroke on the 15th March, which is The Ides of March.
This is not a suspicious day for me, but it was my mother-in-law’s birthday. My late wife always said that we should beware the Ides of March.
Now I didn’t get on too well with my mother-in-law, as she was a lady with different principles to me, but surely my stroke isn’t her fault?
How Am I Doing?
I suppose that I’m OK, and that in itself is probably good news as I only had the small stroke three days ago.
My real problem I suppose is being unable to drive, as this means that I have to rely on the goodwill of others. That is not my style. And if you have been reading this blog, you will know that I like to travel to all sorts of places in both the Lotus Elan and the Jaguar.
Other than that, I don’t have too many problems, except that I find it difficult to drink quickly. As I tend to drink a lot of tea, coffee and diet-Coke, I seem to be trying to drink all day. I think I’m losing weight despite eating quite a lot.
But overall I suppose it’s not too bad.
I could have been much, much worse.
Mephedrone
There has been a lot of talk about mephedrone or meow meow in the news lately.
Can anybody tell me, why anybody is stupid enough to experiment with crap like that?
I’m dubious of legal drugs, let alone illegal ones.
Can Influenza Cause Strokes?
I ask this question in an enquiring fashion, not actually wanting to prejudice the answer. After all I’ve criticised medical researchers on this blog a couple of times for trying to prove a theory rather than solve a problem.
So let’s start with some facts about me.
- I had a stroke on Monday and this winter despite having a flu jab, I got a bad dose of flu. I also remember saying to my housekeeper and she confirmed it, that I thought that the flu was coming back.
- As I write, I have a runny nose and my head feels just like it does when you are getting over a cold.
- I have also had another small stroke in the last perhaps couple of years. This I don’t remember, but I think I can remember a time when I woke up dribbling. But then I had no slurred speech. I vaguely remember telling my wife that I felt odd, but that was it. When exactly it was I do not know.
- I also remember two incidents where I blacked out for perhaps a second whilst driving. Incidentally, both times it was in the Lotus and in one, I know I was getting over the flu and put the incident down to that. Both days were days with a lot of sunlight. I just put them down to the usual migraines that I occasionally get and one to the flu.
So were the last two incidents TIAs.
Two of these incidents definitely involved recent flu.
Now this may all be conjecture and two out of four is not good statistics, so you can make what you want out of them.
But!
This article in the New England Journal of Medicine, which is a respected journal seems to show that if you are vaccinated against flu, then you are less likely to be admitted to hospital with a heart attack or a stroke.
This large study definitely shows that if you don’t get flu, then you are less likely to have a stroke.
But is the reverse true?
More Checks
I went back into Addenbrooke’s today to have the arteries in the neck checked. Apparently, if they’re clogged these can be a cause of strokes.
But mine were fine. Or at least the ultrasound guy said that it wasn’t necessary for me to see a doctor.
I will be thankful for small mercies.
By the way, I’ve had a few ultrasound scans and seen lots with horses, and this is another technology that gets better and better.
I Can Still Ride a Bicycle
Just went out and rode round the buildings on my bike.
So that all works!
Experiencing an MRI Scan
I’ve heard from several people that they don’t like MRI scans. My late wife didn’t, as she found them claustrophobic and noisy. I’ve had two; one on my shoulder and the other yesterday on my brain. They are both, but at least in the second, I was able to see out through a mirror. I’ve also had a CT scan in Naples and apart from the technology, that was a similar experience, although less noisy.
So how does an MRI scan work. This is the first paragraph of an excellent article in Wikipedia.
Magnetic resonance imaging (MRI), or nuclear magnetic resonance imaging (NMRI), is primarily a medical imaging technique most commonly used in radiology to visualize detailed internal structure and limited function of the body. MRI provides much greater contrast between the different soft tissues of the body than computed tomography (CT) does, making it especially useful in neurological (brain), musculoskeletal, cardiovascular, and oncological (cancer) imaging. Unlike CT, it uses no ionizing radiation, but uses a powerful magnetic field to align the nuclear magnetization of (usually) hydrogen atoms in water in the body. Radio frequency (RF) fields are used to systematically alter the alignment of this magnetization, causing the hydrogen nuclei to produce a rotating magnetic field detectable by the scanner. This signal can be manipulated by additional magnetic fields to build up enough information to construct an image of the body.
Note that they call the technique by its real name NMRI. It was called that when I worked on an NMR machine in 1969 at ICI Mond Division. I seem to remember that the guy who ran the department, Eddie Clayton, claimed that one day it will be used instead of X-rays. I don’t think he was believed, but then the first images were taken in 1973, so it wasn’t far off.
The Wikipedia article also explains all the noise.
…These fields are created by passing electric currents through solenoids, known as gradient coils. Since these coils are within the bore of the scanner, there will be large forces between them and the main field coils, producing most of the noise that is heard during operation. Without efforts to dampen this noise, it can approach 130 decibels (the human pain threshold) with strong fields.
So it’s just mechanical interaction and not somebody trying to operate on your head with a road drill. I’m partly deaf, or rather I have frequencies missing, so it doesn’t bother me.
But the real power of MRI scans is that show the body in amazing detail that enables problems to really be diagnosed. In the first use of the technique they looked at my shoulder that had given me trouble all my life. They ascertained that there was no serious problem and that exercise rather than surgery was the best way to proceed. That was good news, not like yesterday’s.
But only a few years ago, neither diagnosis would have been possible.
Dribbling in Style
I now dribble and find drinking difficult.
Today, I’m going to find some large linen napkins, so that at least I can do it in style.
Cannulas
I’ve never had a cannula fitted until yesterday. As Addenbrooke’s might have wanted to take a lot more, they fitted one.
I didn’t feel it all day and today, I just have a slight mark on my arm.
So don’t worry about having one fitted. There are worse things in life.
The Anonymous Widower 