So you don’t have to search the forum for my previous post to catch up, my 62 year old wife of 41 years had a stroke after running a 5K. No symptoms, her lights just went out. We thought she would recover and then suddenly passed away 4 months later while in rehab. I received the autopsy results Thursday.
The initial stroke was caused by a blood clot in the left MCA. We knew this a few minutes after arriving at the hospital. The autopsy showed that her death was the result of another stroke in the right MCA. Both strokes were caused by a 90% blockage of the MCAs. There was no significant blockage of any other major vessel.
I spoke to my cardiologist because I did not understand how this could of happened. She told me that what happened to my wife can happen if a woman has a particular long and difficult menopause. My wife had been having hot flashes and night sweats for 15 years. The test for this is a sonogram of the MCA’s and takes less than 15 minutes. If you see a cardiologist for any other reason you have probably had the test. My wife had no known reason to go to a cardiologist.
Heads up. If this knowledge saves one person on the board she will not have died in vain.
Really sorry to hear about your wife and thank you for posting that information.
I have never had any heart issues but decided to get a pre-emptive scan because some guys at work were getting them and my company would pay for it. They found I have an abdominal aortic aneurysm. No symptoms and they don’t plan to do anything but just watch it right now. But testing early is the key.
Thank you for taking the time to post this. I will talk with my wife and ask her to consider getting this test. She is an RN, so she may already be aware - but I’m going to ask for my own peace of mind.
I’m so sorry for your loss. I had been following the other thread but hadn’t been on here for awhile. I admired your tenacity in making sure she received the care she needed and deserved. I know how hard it is to be the caretaker of your spouse but I also know how much it matters. I also admired her grit and determination. She seemed to be one special lady.
Is there a certain time or age when one should have this sonogram? I don’t know anything, but this doesn’t sound like a routine test and is instead something to ask about. Is thag right?
Again, I’m so sorry. You have a good group here, so please let us know if you need anything. I know others here have helped me.
Honey is a CT/X-ray tech, and she’s had some weird things going on this year, so this is a rather well-timed, informative post. I’ll copy and paste verbatim what she sent back to me:
"Okay so what I’m seeing an ultrasound is done basically through the skull so it makes it a little bit more difficult and it’s done to look for flow. However, a CT angiogram which is what I’ve had done two almost three times now is actually more accurate for MCA blockages
“Ultrasound is generally done because insurance is will easily pay for it. Whereas CT you have to get pre-authorization”
Thanks again, Jack! She will be aggressively persuing this at her next follow-up in the spring!
Thank you for continuing to share your life and experience for all. And continued thoughts for you and your family.
I went and reviewed a handful of the medical literature. We do know that Menopause can increase overall risk factors that can contribute to thrombophilia, which means increased risk for different clotting events. This includes increase in general atherosclerosis and in turn carotid artery disease, which are the main branches that leads to the MCA. This is one major risk factor, of many, for stroke. As with cardiac disease in general, family history and genetics also a factor. Similar to why we have so many posts on health triathletes with heart disease. Early menopause (average age 43 based on another study I saw) is an increased risk in and of itself.
I think this PSA is a great service and reminder for people to be sure they have good relationships with a trustworthy PCP so they can review their individual health and ask about timing and indication for focused testing such as Carotid Ultrasound, which is what I am almost certain your Cardiologist referenced.
Accuracy of noninvasive vascular imaging — Noninvasive imaging methods (mainly MRA and СТA) are useful for excluding moderate to severe (50 to 99 percent) stenosis of large proximal intracranial arteries and are usually sufficient to identify intracranial arteries with moderate to severe stenosis. However, MRA and СTΑ have certain limitations related to accuracy and sensitivity when compared with the gold standard of catheter аոgiоgraphу. As examples, noninvasive methods may not be sufficiently accurate to differentiate an occlusion from pseudo-occlusion with critical stenosis or to confirm the severity of a clinically significant stenosis. In addition, they tend to overestimate the severity of stenosis. In the prospective multicenter SONIA trial of patients with ТΙA or ischemic ѕtrokе who were suspected of having intracranial large artery stenosis, both ТСD ultrasonography and MRA had high negative predictive values (86 and 91 percent) and low positive predictive values (36 and 59 percent) for the detection of intracranial stenosis in the MCΑ, intracranial ICA, vertebral, and basilar arteries compared with catheter аոgiοgraрhу [27]. Similarly, a subsequent report from SONIA found that CТA had a good negative predictive value (73 percent) and a low positive predictive value (47 percent) [28]. Nevertheless, intensive medical therapy is indicated for patients with a first event related to symptomatic intracranial large artery stenosis detected by noninvasive imaging (see “Intracranial large artery atherosclerosis: Treatment and prognosis”); more precise characterization of the stenosis with catheter аոgiοgraphy would not affect the initial management in most cases.
This is from uptodate. The positive predictive value of transcranial ultrasound is about 35-40 percent. Meaning that if it says you have an ultrasound saying you have a highly stenosed MCA there is only a 40 or less chance you actually have it. Studies usually have highly trained operators so real world accuracy is likely less. Doctors would not base a treatment decision on that kind of accuracy so to know for sure you would have to do intracerebral angiography which carries a one percent stroke risk. Furthermore there are no studies that show that strenting or doing a ballon angioplasty on a narrowed MCA is a good idea the ones that have been done show a higher risk of doing the procedure vs not. The studies were done on pts who already had a TIA or stroke. I’d be really leary of anybody who wanted to mess with a MCA that had no symptoms. So I am not sure what the utility of having a transcranial ultrasound would be and it could cause harm.
I am very sorry for what happened to your wife. Aside from treating elevated cholesterol, bp and the like did the cardiologist suggested anything specifically targeted at the MCA would have prevented the stroke?
Understood. I am speculating. But am comfortable doing so, having just sat for and passed my Neurocritical Care Boards this past fall, as I work a portion of my time in a dedicated Neurosurgical ICU, and decided to take it since I manage the acute events like this.
I don’t want to confuse things too much. But I am pretty sure the recommendation was for Carotid US. That is minimally invasive, only takes 15-20 minutes as Jack noted, and there are clear criteria (I know you know). This would be the general and appropriate screen.
What you note MRA, CTA, Angiography and possibly Transcranial US are generally if someone is deemed high risk by US and need next steps prior to intervening.
It is one of two (left/right) arteries that supplies a large portion of the brain. A complete occlusion can be devastating, one of the worst if not worst strokes someone can have.
As a woman I really appreciate you sharing this information I had never heard about.
The lack of medical understanding of menopause and its impacts are scary. I’ve tried to learn about impacts on dementia and it seems like there should be a lot more data than there actually is.
The way private insurance is in the US, I would be surprised if they would actually pay for any of these diagnostic tests for a neurologically asymptomatic individual. Even when my coronary calcium score came back >400 (90th percentile for major cardiac event), insurance refused to pay for cardiac cath to evaluate for CAD. I ended up paying out of pocket for a CT coronary angiography.
