Will numbness every go away and am I likely to have another stroke?

Kennithsims asked...

I am a 52 year-old male and in September of 2009 I had two strokes. The first was mild with numbness on left side of body from face to feet. I still am having problems with my left hand. It's very hard to hold on to anything. Two weeks after the first stroke I had the second one, which was much stronger. A hole was found in my heart. The doctors tried to repair the hole but it was to small for the devise to go through. I'm on seven different medications twice a day - I guess for the rest of my life.

I have two questions. 1. Will the numbness in the hands and face ever go away. 2. Am I at a high risk for another stroke? I have asked these same questions to my doctor and have gotten unclear answers.

Expert Answer

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

You have probably gotten unclear answers because there is no clear answer. In my experience, most people assume we have great data to give an exact answer to a question like this. Unfortunately, no such data exists. I often compare a Stroke Neurologists ability to predict the future with that of an Economist or a Weatherman - which is to say, very unreliable.

With regards to your numbness, in general, stroke symptoms tend to improve slowly but steadily for about 6 months, then level off. The best way to predict improvement is for you to chart your progress on a graph over time. You can extrapolate the line out to about 6 months from the time of the stroke (keeping in mind that the improvement slows the farther out from the stroke you are).

The possibility of having a recurrent stroke depends entirely on the cause of the initial stroke. I find it somewhat hard to believe that the hole in your heart is the clear-cut cause. "Holes in the heart", or "PFO"'s, are found in about 25% of the population, and are rarely the cause of a stroke. That, together with the fact that 1)your strokes were so close in time to each other, and 2)the hole was "too small" to close, all seem very suspicious that the true source has not been identified.

Given your age, I would recommend an evaluation including MRI of the brain, non-invasive angiogram of the head and neck - either CT angiogram or MR angiogram (a stand alone ultrasound of the neck is not sufficient in someone your age), a hypercoaguable (clotting) panel, and a prolonged cardiac electrical monitor. I assume you have already had an ultrasound of your heart based on what you wrote.

Only when a cause of the stroke is known can a reasonably accurate guess as to the recurrence risk of the stroke be given.