James Castle, M.D.

Caring.com Expert

About: James Castle, M.D. is a neurologist at NorthShore University HealthSystem (affiliated with The University of Chicago) and an expert on strokes.

Recently Published on Caring.com

Monday November 02, 2009
1. After my stroke, I lost my sense of taste, Will this change?
  Answer - I have heard a few people tell me that they lost their sense of taste after a stroke. In general, I think of this as being similar to other deficits after a stroke. Gauging how much and how quickly an improvement will occur is very difficult.
Wednesday October 21, 2009
1. Is the skin problem stroke related?
  Answer - I haven't heard of this exact type of thing happening to someone after a stroke. Two things come to mind, however. The first is that he could be having pressure sores or stasis swelling from not moving the arm and leg (I am assuming that the dryness is only on the side affected by the stroke)...
Monday October 19, 2009
1. Can you have post stroke symptoms even years afterwards?
  Answer - The general rule of thumb regarding stroke symptoms is that they improve slowly over time. Any new symptoms should prompt a workup for another disease.
Monday October 12, 2009
1. Mom had a stroke in 2006. Her stroke did not affect her left...
  Answer - I do not think you are being overly hopeful. Although I have not personally heard of someone recovering from stroke symptoms more than 2 years after their stroke, there is no inherent reason why she couldn't continue to have some improvement after 2 years.
Monday October 05, 2009
1. Is dizziness and falling normal after a stroke?
  Answer - It sounds like her stroke affected the balance centers of the brain - usually in areas called the "cerebellum" and "brainstem". It is not unusual for patients to have problems with falling after such a stroke.
Friday October 02, 2009
1. Can supplements aid in stroke recovery?
  Answer - Unfortunately, there is no "magic bullet" for stroke recovery. The best, and most widely used, method for recovering from a stroke is aggressive physical and occupational therapy. If possible, try to go for three hours a day of therapy. If your insurance company does not pay for that much, ask your...
Thursday October 01, 2009
1. What is a RIND stroke?
  Answer - RIND stands for "Reversible Ischemic Neurological Deficit". It is a term that is not widely used anymore. In layman's terms, it means a stroke that the patient was able to fully recover from within a few weeks. This is opposed to a TIA, or "Transient Ischemic Attack", in which the patient recovers within 24 hours...
Wednesday September 30, 2009
1. Are my father's seizures related to his Alzheimer's?
  Answer - Seizures are, unfortunately, fairly common in Alzheimer's patients. Seizures can be thought of as small "short-circuits" in the electrical brain activity. They almost always start on the outer surface of the brain.
Thursday September 17, 2009
1. Will he recover from this stroke?
  Answer - Unfortunately, I don't have a great answer for you. Recovery after a stroke is notoriously hard to predict. The only rule that is almost always true is that the patient should not get worse over time. Beyond that, some people make no recovery, some people make a moderate recovery, and some people make a complete recovery...
Tuesday September 08, 2009
1. Can post-stroke leg pain be treated?
  Answer - It is not uncommon to have severe tightness, otherwise known as spasticity, in an affected limb after a stroke. This occurs because of lack of control of the spinal reflexes to the limb.
2. What could be causing these post-stroke symptoms?
  Answer - The thalamus is a very important part of the brain, and a stroke there can be quite debilitating.
Monday September 07, 2009
1. How long does it take to regain speech after a stroke?
  Question - How long does speech take to come back after a stroke? Speech recovery varies, but most recovery takes place in the first two years after a stroke.
Monday August 24, 2009
1. Can a stroke cause swelling and spasms?
  Answer - Swelling and muscle spasms after stroke are fairly common, but not on the side unaffected by the stroke.
Thursday August 13, 2009
1. Why is my father's leg swelling after a stroke?
  Answer - Very sorry to hear about your father. It sounds like he had a large stroke. Unfortunately, predicting recovery from a stroke is very difficult - notoriously innacurate. Since he is 13 days out from the stroke, it would unlikely that he will get any worse at this point, but how much he improves is near impossible to say...
2. Is it common or expected for a person (58 yo) to continue to...
  Answer - Continued deterioration after a stroke is not common, and it sounds like she needs further evaluation.
Saturday August 08, 2009
1. Is this constant headache related to my stroke or something else?
  Answer - Headache is not a common symptom after a stroke. When it occurs, a few questions go through my mind. They include: 1) Could there have been bleeding at the location of the stroke? 2) Could there have been swelling from the stroke that caused stretching and pain in the sensitive areas around the brain...
Friday August 07, 2009
1. What would cause total weakness in limbs?
  Answer - Stroke after carotid endarterectomy is a fairly common complication of the surgery. However, it should almost always affect only one side of the body. There are a few exceptions to this. Sometime, the carotid artery on one side of the neck will supply blood to both sides of the brain, either because...
Monday August 03, 2009
1. Does numbness in my back mean I'm about to have a stroke?
  Answer - Having arm, leg, and back numbness could mean you are having a stroke. A large determinant is whether one side of the body is affected, or the whole body. If the numbness is contained to one side, this could certainly mean you are having a stroke - in this case, most likely a small stroke in a part of the brain called the "thalamus"...
Tuesday July 28, 2009
1. Is there such thing as TIA memory loss?
  Answer - It sounds like you could have a serious condition, and based on what you are telling me, I think you need to get yourself to a large, tertiary, Neurology clinic for evaluation, and soon.
Sunday June 14, 2009
1. Can treatment for neck pain cause a stroke?
  Answer - In my experience, chiropractic manipulation can cause strokes. There is a particular maneuver where the chiropractor twists the neck that can cause tearing of the vertebral artery as it runs through the neck bones. However, to my knowledge, this typically would cause an ischemic stroke from a clot formation in the artery due to a tear...
Tuesday May 26, 2009
1. Are new fears after a stroke common?
  Answer - Having new fears after a stroke is certainly possible. The brain is made up of many small areas that each control a specific function. For example, one area controls moving your left thumb, another area controls temperature regulation, and another area controls sensation in your right foot. There are also areas that control behavior and personality...
Wednesday May 20, 2009
1. Why doesn’t Dad take his health seriously?
  Answer - It sounds like you need to get very tough with him. I agree with you, this is no laughing matter and it always pains me when a parent is not taking their health seriously, leaving it to their children to press them on the issue.
Friday May 08, 2009
1. What causes head pain after stroke?
  Answer - Your story reminds me of a great quote from Hamlet: "There are more things in heaven and earth, Horatio, Than are dreamt of in your philosophy."
Tuesday May 05, 2009
1. Is swelling normal after a stroke?
  Answer - Yes. This is something that I frequently see after a stroke. I think it is important, particularly in the case of your leg, to make sure there is no clot in the veins of the leg. An ultrasound should easily verify that the veins are open. Ask your doctor to evaluate your leg and order an ultrasound if they think it is appropriate...
Monday May 04, 2009
1. How can I help the nurses to not be offended?
  Answer - This, unfortunately, can be a very tricky issue.
Wednesday April 29, 2009
1. Are tremors likely after a stroke?
  Answer - The answer to this question depends on what you mean by "tremors". That term makes me think of two different possibilities - seizures or clonus.
Tuesday April 28, 2009
1. Can you get vascular dementia from stroke?
  Answer - These are great questions, let me try to tackle each one in turn:
Monday April 27, 2009
1. Can we treat my husband's depression better than all the drugs he's been given?
  Answer - I'm sorry to hear about this. Depression after a stroke is very common, and it certainly does not help to have other regrettable life circumstances.
Monday April 20, 2009
1. Can pain be a sign of impending stroke?
  Answer - Assuming this is an "ischemic" stroke - or one in which the stroke is caused by a blockage of blood flow - chronic pain is not typically a sign of an impending stroke, with a few exceptions. These would include 1) a tight blockage of an artery or 2) a torn artery. Both of these are very rare causes of a stroke...
Monday April 13, 2009
1. Is it normal to have the sensation of tightness after a stroke?
  Answer - I think there are two possibilities in this situation. The first is that your father is suffering from "phantom" sensations - common after a stroke. When the sensory connections between a limb and the brain are damaged, there is poor communication between the nerves and the brain and the brain can sometimes interpret this in uncomfortable ways...
Wednesday April 08, 2009
1. Are sleep problems after stroke common?
  Answer - Stroke can cause sleep deprivation by a multitude of different ways. Those include, but are not limited to, 1) Post stroke anxiety, 2) Post stroke depression, 3) Medication effect, 4) Post stroke sleep apnea, 5) Uncomfortable body positioning due to weakness/stiffness, 6) Alteration of sleep/wake cycle...
2. Could hearing a gunshot sound in head be a stroke symptom?
  Answer - This does not sound like a stroke symptom. Strokes would not be expected to cause the sensation of a loud noise - unless it was associated with a severe headache - which could indicate a sudden bleed in the head. I would suggest they be seen by their primary care physicians, and that imaging of the brain be considered...
Monday April 06, 2009
1. Could the reason I stopped having migraines be because I had a stroke?
  Answer - That is a fascinating story - and there is probably a connection. However, unfortunately, so little is known about the cause of migraines that I can't tell you for sure what science underlies your particular case.
2. Are my headaches and feeling like I can't breathe related to my stroke?
  Answer - Headaches are somewhat of a rare complication of stroke - in my experience, more commonly seen with "bleeding" strokes than with "clotting" strokes. When they occur, they can indicate swelling, bleeding, artery tearing, clotting in the veins, or a very tight (nearly occluded) artery...
Wednesday April 01, 2009
1. Where can I find a local neurologist?
  Answer - I'm not sure exactly where you are located, so it is hard to know. You could try asking around to various local primary care doctors if they know of a good Neurologist. Typically, any nearby academic center should also have a stroke specialist, as well as several Neurologists.
2. Should I seek a second opinion about my stroke recovery and meningioma?
  Answer - It is somewhat hard to know the answer here without knowing the location of the stroke and the meningioma. By age 55, it is not uncommon at all to have incidental old stroke and/or meningiomas seen on routine brain imaging. If they are not in the right location (usually an area known as the "posterior...
3. Could this occasional stabbing pain in my head be a precursor to stroke?
  Answer - This does not sound like a precursor to a stroke. It sounds more like an "ice pick headache". They usually respond well to medications.
Tuesday March 31, 2009
1. Will going off blood thinners before surgery cause a stroke?
  Answer - Unfortunately, this is a bit of a sticky situation. For his upcoming surgery, there is no choice but to have him off blood thinners. The good news is that the chance of stroke while he is off blood thinners is very low, given that it is such a small window of time...
2. Are strokes at a young age common?
  Answer - It is not typical, but also not completely uncommon. Stroke in a young person is often caused by different diseases than stroke in older people. Unlike the common ailments of old-age, such as cholesterol plaques, irregular heart rhythms, etc., stroke in the young requires a different evaluation.
3. Could these symtpoms be side effects of stroke or depression?
  Answer - The symptoms you are describing are not all too uncommon after a stroke. When the connections between the brain and the peripheral nerves is interrupted, there are often disturbing symptoms that follow. I compare this to the "phantom" limb pain that amputees will have...
Friday March 27, 2009
1. Are hyperbaric dives a possibility for relieving post-stroke issues?
  Answer - Sorry to hear about your situation.
2. What kind of doctor should we see for stroke recovery issues?
  Answer - I would recommend you start by seeing a stroke doctor. Your husband should not have any worsening of his left side this far out from a stroke. It sounds like he needs to have a review of his case to make sure that there is no active problem making him worse.
3. What are the chances of another stroke?
  Answer - The chances of having a second stroke depend a great deal on what caused the initial stroke. In someone your age, the usual causes of stroke are 1) a tear in the artery, 2) an inborn problem with the arteries, 3) inborn heart disease - such as a hole in the heart, or 4) a clotting disorder.
4. Am I doing the right thing by following the doctor's orders and not bringing my mom in when she has a TIA?
  Answer - Very sorry to hear about this situation.
Thursday March 26, 2009
1. Are strokes hereditary?
  Answer - A predisposition to strokes can be hereditary, but there is no reason to think that you are destined to have a stroke.
2. Can severe migraine headaches cause a stroke?
  Answer - Migraines can cause a stroke, but that would be extraordinarily rare. If you do not have stroke-like symptoms with your migraines (such as weakness of an arm, leg, or part of your face; or numbness in those same areas) it is very unlikely that you would ever suffer a stroke...
3. Should my mother see a stroke specialist for memory loss due to a mini stroke?
  Answer - As a stroke specialist myself, I have a bias that there is no substitute for seeing a stroke specialist to help determine the cause of a stroke, and how best to prevent another stroke.
Wednesday March 25, 2009
1. What can be done about my husband's ongoing stroke pain, and does it mean there's another one coming?
  Answer - Head pain is not common during, or after, a stroke. When it occurs, it may be a sign of 1) bleeding, 2) a tear in one of the arteries, 3) a clot in one of the veins, 4) opening up of smaller arteries when one of the larger ones is occluded, or 4) a side effect of his medicine...
Tuesday March 17, 2009
1. Are these symptoms side effects of stroke?
  Answer - Sorry to hear about your situation.
Friday March 13, 2009
1. Are strokes or Alzheimer's to blame for my mother's memory loss?
  Answer - Often, it is very difficult to tell if someone is having memory loss from multiple small strokes, or from Alzheimer's disease. A particular challenging part of the problem is that Alzheimer's can only be definitively diagnosed by looking at the brain under a microscope - in other words, in a post-mortem examination...
2. Is it normal to have hallucinations after a stroke?
  Answer - In summary, yes, and yes.
Thursday January 15, 2009
1. How long do stroke symptoms last after a brain stroke?
  Answer - Unfortunately, this is a very difficult question to answer. The general rule I use is that if people survive the initial days of the stroke, and the complications during that early phase, they almost always have some improvement. However, the amount of improvement is extremely variable. Some patients return to normal, some only have very mild improvement...
Tuesday January 06, 2009
1. My father had multiple strokes during an open heart surgery...
  Answer - I'm very sorry about your situation. In general, open heart surgeries come with two different types of potential neurological complications. The first is multiple small strokes. This occurs most commonly when the aorta (or the large artery coming from the heart) is unclamped near the end of the procedure...
2. Did my mom have a stroke or just a migraine headache?
  Answer - Migraines are a very cryptic phenomenon, not completely understood by Neurologists. They cause spasm of the blood vessels, and spreading depression of electrical activity across the brain that can mimic a stroke or TIA (transient ischemic attack). In my experience, they, along with seizures, are the most common mimic of stroke and TIA...
3. Could a burning sensation on the left side of my head be a stroke symptom?
  Answer - The fact that this sensation only comes on with anxiety and stress makes it most likely a benign headache type, such as a migraine or migraine variant.
Tuesday November 18, 2008
1. Can damaged brain cells from a stroke take over healthy cells over time?
  Answer - Brain cells damaged in a stroke cannot take over healthy cells.
2. My son had a stroke- how do I get him to take his medicine?
  Answer - Depending on the reasons someone's not taking stroke medicines, there are a number of approaches to help.
Thursday September 18, 2008
1. What can I do about my mother, who is being verbally abusive due to a stroke?
  Answer - How to deal with someone who's verbally abusive after a stroke.
2. How can I handle my father's post-stroke outburts?
  Answer - What can be done when someone throws tantrums and behaves inappropriately after a stroke.
Monday June 09, 2008
1. My husband suffered a stroke and still sometimes feels a burning sensation in his head. Why?
  Answer - Posterior circulation strokes can cause a false sense of discomfort. Here's what you can do.
2. What is the long term prognosis for a 58 year old man who had a TIA and clot buster with nearly full recovery?
  Answer - A TIA is different from a stroke. Stroke symptoms usually get better with time.
3. Is it common for a stroke survivor to be less tolerant of heat?
  Answer - After a stroke your body's thermostat can malfunction. Here's what might help.
Monday April 28, 2008
1. How do you deal with aphasia?
  Answer - Suggestions for helping dad with aphasia communicate.
2. How do I help my mother get over or cope with her fear of falling?
  Answer - Advice for helping mother overcome her fear of falling due to vertigo after a stroke.
Monday March 17, 2008
1. How long does it take to regain speech after a stroke?
  Answer - It may take time to recover speech abilities after a stroke.
2. What can be done about excessive sleepiness after stroke?
  Answer - James Castle offers advice for dealing with sleepiness after a stroke.
Tuesday February 19, 2008
1. What's the best way to deal with my dad's incontinence after his stroke?
  Answer - Dealing with bowel incontinence can be very tricky. I would recommend trying to stay on top of this issue by scheduling regular trips to the bathroom. To some extent, you can regulate the timing of your father's bowel movements by using stool softeners, laxatives, and enemas in a controlled and timed...
2. What are the risks of general anesthesia after a stroke?
  Answer - Usually general anesthesia poses little risk to patients who have suffered hemorrhagic strokes, which are most commonly caused by elevated blood pressure or abnormal blood vessels. Unless your mother's surgery requires that she not take blood pressure medicines beforehand, general anesthesia would be...
3. How should we deal with my dad's anxiety attacks after his stroke?
  Answer - A stroke is a very stressful and scary event; anxiety after a stroke is common, and some people even suffer from post-traumatic stress disorder. It sounds like your father is suffering from anxiety and might benefit greatly from the help of a professional, either a psychiatrist or psychologist...
4. Can a TIA have residual effects?
  Answer - By definition, a TIA should cause symptoms that last no more than 24 hours. If your mother is still having symptoms from an event that took place last year, this would be considered a stroke, not a TIA. That said, with regards to vascular dementia, a TIA can cause damage to the brain that is not noticeable to the patient but can be seen on radiologic imaging...
Monday September 10, 2007
1. Why is my mother so angry and abusive after her stroke?
  Answer - If your mother's stroke involved the part of the brain responsible for behavior, you may be in for a rough road ahead. Generally, most of the improvement after a stroke is within the first six months, but improvement can continue for up to two years.
2. How can I be sure that a headache after a stroke isn't a ministroke, or TIA?
  Answer - Transient ischemic attacks (TIAs), also known as "ministrokes," are almost always painless. Headaches after a stroke are fairly uncommon, but they might occur for the following reasons:
3. How can I tell whether my father's incontinence after his stroke is temporary?
  Answer - Incontinence is quite common after a stroke. It's not unusual for a stroke victim to require a great deal of assistance with going to the bathroom; some even require a diaper.
4. How can I encourage my mother to be more independent after her stroke?
  Answer - I'd enlist the help of your mother's doctor or physical therapist. Make the visit together and ask your mother's provider to instruct her on what is and isn't safe for her to do by herself. Once that's clear, let your mother do those things on her own.
5. How can I help my kids understand their grandfather's aphasia after his stroke?
  Answer - This is a tricky issue. Depending on how old your children are, you could try explaining that because your father-in-law got sick, his language abilities are similar to those of a younger child, such as a toddler.
6. Is there anything that will help relieve my dad's pain after his stroke?
  Answer - Chronic pain following a stroke is often due to increased contraction of the muscles affected by the stroke, similar to cramping. This can lead to contractures (muscle tightening that prevents normal movement) and pain in the muscles and joints.
7. Why are my father's abilities improving and then regressing since his stroke?
  Answer - In general, patients should slowly improve after a stroke. After about two years, this improvement tends to slow down substantially. However, any reappearance or worsening of symptoms should prompt a medical evaluation.
8. What can I do to encourage my father to work on recovering from his stroke?
  Answer - Your father may be suffering from depression, which affects as many as half of people who've had a stroke. Symptoms of depression can include a lack of energy and interest, along with changes in appetite and sleeping habits, agitation and restlessness, and crying episodes...

James Castle, M.D.

Caring.com Expert

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