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JIM was quite apologetic about coming to see me.

"I feel champion now doc, but the wife insisted that I come". He described how when he woke that morning his arm felt strange, he couldn't shave properly and the can opener completely defeated him as his fingers wouldn't do what he wanted them to.

He found it difficult to talk sensibly and his cheek felt like it does after the dentist has been injecting local anaesthetic in your mouth.

This lasted through breakfast so his wife booked him in to see me. When I saw him all his symptoms had gone. A quick examination from top to toe showed that he could see clearly, smile, puff his cheeks out, feel me touching his face equally on both sides, stick his tongue out, tell me about the quick brown fox jumping over the lazy dog and shrug his shoulders strongly. He could push me away by straightening his arms equally on both sides and lift his knees up against resistance. When he held his arms out at arms length and closed his eyes they did not move. He could squeeze my fingers equally and could touch his nose.

Lastly he could walk toe to toe across an imaginary tightrope on the floor without falling off. These are all tests I would do to see if a person has had a stroke. All in all there was no sign that he had suffered from one.

He had experienced a Transient (meaning something that had settled down) Ischeamic (part of his brain had been short of blood and therefore oxygen) Attack, otherwise known as a TIA.

These are all serious as they can lead to a stroke, some are more serious than others, to find out the risk you need to know your ABCDD.

A stands for Age - if you are over 60 you score one.

B is for blood pressure - more than 140/90 scores one.

C is clinical features - scoring one for dodgy speech and two for weakness on one side. D is for duration - less than 10 minutes doesn't score, 10 minutes to an hour is one point and over an hour scores two. D is also for diabetes - if you have it you get another point. Jim scored six. This means he has an almost one in 10 chance of a complete stroke within two days so we arranged for him to be seen urgently.

A low score means that the urgency is less and a routine appointment is safe. I prescribed him aspirin in the meantime, the hospital will decide if he needs surgery to an artery in his neck to improve the blood supply to his brain.

I will try to help him kick the cigarettes.
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Title Annotation:Features
Publication:Evening Chronicle (Newcastle, England)
Date:Nov 2, 2009
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