In the course of reading up on strokes for a story I’m brainstorming, where a very elderly character dies from one, I came across something really interesting, and something that might explain a lot about my own medical history: it’s called “silent strokes”. Yes, a stroke can strike without any obvious stroke-like symptoms.
So-called “mini-strokes”, strokes that strike but then resolve within a day and usually with mild stroke-like symptoms, are much more common than the famous major strokes (that are often debilitating). Silent strokes are still more common than mini-strokes; in fact, silent strokes are thought to be around five times as commonplace as all other not-so-silent strokes put together. And just as having a mini-stroke greatly increases your risk of having a major stroke in the future, so too does a silent stroke increase your risk of having any sort of not-so-silent stroke (mini or major). Often people experience silent strokes before going on to contract mini-strokes, which then herald the major strokes that are so often deadly.
Mini-Stroke in Midlife…and previous Silent Stroke in Childhood?
I’ve always been quite familiar with the signs and symptoms of stroke and even mini-stroke, considering it’s by far the leading cause of death in my family tree, but I hadn’t heard about silent strokes until this week, particularly silent strokes in children. Then I thought back to my mother’s childhood, and a lot of things started making sense. After a mini-stroke in midlife she started showing cognitive deficits, consistent with either nonfluent-variant primary progressive aphasia or (perhaps more to the point) vascular dementia. And she always had (what in hindsight was obviously) relatively severe attention deficit disorder as early as childhood, as well as some of the nfvPPA symptoms in much milder fashion, and other cognitive deficits (particularly affecting abstract-mathematical ability). Might they have been due to a silent stroke she suffered even back then? Maybe.
Once as a child she had a tonsilectomy, and she lost so much blood as a result she almost died. Also in childhood she also had one of the most severe cases of chickenpox ever recorded; bedridden for a month, with the pox even being inside her throat (needless to say given that family history she made a point of getting me the chickenpox vaccine as soon as it was available). Both of these sort of events are known to bring on silent strokes, especially in people with a family history of strokes (which she had and I have) and antiphospholipid syndrome (which it later came out she had!), and, very interestingly, her cognitive deficits she suffered from for the rest of her life only really started to appear after these incidents. Before then she was much more normal.
Unfortunately this was the 1970s, and silent stroke, especially in children, wasn’t well-known; it’s a quite obscure malady even now! A definitive assessment could only have been made with an MRI or CT scan of her brain, and she never had such a thing done. Still, I strongly suspect silent stroke brought on by those episodes of severe illness.
Am I a Silent Stroke Victim?
Worse yet, I strongly suspect I’ve had silent strokes. One time as a child I was riding my bicycle without a helmet and (in truly cringe fashion) I had an accident on my own driveway, slamming the left side of my head onto the concrete, right on my left ear. Blood poured out of it for a while, and it hurt really badly; I was taken to the doctor and had my left ear inspected for the slightest sign of any damage or trauma, and nothing was found. Everything was intact and normal. Yet gradually after the accident I lost hearing acuity in my left ear, and to this day I can’t hear quite as well in it as I can with my right ear. It never got better, yet there was no damage to the physical structures.
This week I learned that if the trauma brought on a silent stroke it could have affected the parts of the brain responsible for the left ear; considering the ear was bleeding, there’s a strong chance a bleeding or some sort of vascular event was happening deeper in my head, i.e. a silent stroke. I didn’t even realize it at the time, but looking back on it, that was also around the same time I developed an “astigmatism” in my left eye!
My cousin has one, so I always thought it was hereditary, but vision in my left eye dramatically worsened after the incident; fortunately not to the point I require correction just to see adequately out of it, but it was deficient to the point my family and I decided to go to the optometrist and get me a prescription for eyeglasses to try out, which I ended up throwing away on account of it not helping. Well, it might not, if the visual deficit was in the brain, rather than the eyeball! It’s not a medical professional, but for what it’s worth ChatGPT suggests that an optometrist or ophthalmologist might have misdiagnosed my problem if it was indeed a visual deficit due to silent stroke.
My left eye visual deficits have a rather odd presentation anyway. It’s like my visual acuity is patchy; in some areas of the field of vision it’s better, and in some areas it’s worse, as if the lens is lumpy in some fashion (not sure if it’s the right analogy; I’m not an optics expert to say the least). I don’t have the “can’t see out of a whole side of the eye” thing that’s the classic stroke symptom (silent or otherwise), but silent stroke has been known to cause the sort of visual deficits I have; even more suspicious is how it’s on the same side as the affected ear, the left side (strokes commonly affect one side of the body).
Intriguingly, looking back on it, after that incident my natural propensity for double vision (which I had even before) also got noticeably worse and has never recovered since; when I relax my eyes I see double, and yes, I can bring it together with modest effort, but it does seem to be more of a strain for me than it is for most other people. That too suggests some sort of problem in the brain, rather than anything physical going on in the eyeball; for what it’s worth no propensity for being (physically) cross-eyed has ever shown up in any test I’ve ever taken. Hmm.
And although this is a rather nonspecific symptom, I’m a natural klutz (like many other dancers, amusingly enough) and frequently bump into things, fling cups off tables with my arms as I move around, and clumsy stuff like that; this characteristic also noticeably worsened after the incident, and my faculties in that area have never recovered since, which is also a hallmark of a silent stroke.
There might have even been a second silent stroke. Once, when I was 16, so considerably older, I got myself injured in the woods on one of those waterfall trails that abound in this country, falling onto my legs in painful fashion, which left me out of commission for days, but wasn’t severe enough to require medical attention beyond my family just taking me home and to bed for a few days. That injury brought on some rather odd symptoms: I had dizziness for quite some time thereafter, and a really bad headache, as well as symptoms that manifested in the vision. Hmm.
I’ve always been prone to seeing bubbles moving across my field of vision whenever I look at a bright object (like the daytime sky, for example) along with bright point-like white flashes scattered over it, but right after that injury and for a long time afterwards it was much worse than usual. Most bizarrely, I saw a small rippling dark distortion right in the middle of my field of vision when I looked at anything; like ripples of dark distortion in a small central spot radiating outward before dissipating. It was subtle, but very apparent whenever I looked at a light-colored or bright object and there was more contrast. I remember thinking it was odd, but after the first day it disappeared and I didn’t think much about it afterward…until this week.
In hindsight, those are some really weird symptoms; normally your leg getting injured doesn’t cause your vision to go haywire. Looking back on it, it’s more suggestive of a vascular/neurological problem that the injury might have brought on…such as a silent stroke.
And although I didn’t even connect the two at the time, gradually after that incident, in the following year or so, I became very sensitive to heat. Hot weather has never agreed with my body, but around that time I started to be sensitive to the point where being outside in 80-degree weather caused me to get heat stress, such as an uncontrollable itching sensation all over my body and feeling like I was going to faint if I stayed out in the sun for more than a short time. That plateaued for a few years in my mid teens and has gradually returned to my childhood-vintage normal level of heat sensitivity since. I always figured it was hormonal, but in light of how silent stroke’s effects can gradually come on over a period of months after an incident, and in light of how (at least according to ChatGPT) much greater heat sensitivity can be a symptom (albeit an uncommon one), I suspect it might have been caused by silent stroke.
Cognitive symptoms don’t seem nearly as pronounced as after the first time, but I have long felt like my brain, mind, and body don’t work quite as well as they all did in my early to mid teens; to some extent this is normal, since scientific studies have found that raw brainpower usually peaks at around age 13 (yes, really), and I always chalked it up to that effect, but now I can’t help but wonder if something else might have happened to me.
Allergic Reactions, Silent Strokes, and Steroids
If I am prone to silent strokes, however, there’s one incident that should have caused one but by all indications didn’t: once, in between these two incidents, I was given a dose of penicillin for a sickness, and I had a severe allergic reaction, one of the worst cases of hives that any of the doctors we saw had ever even heard of. My whole body swelled up like a balloon, and my fingers and toes to this day have never completely resumed the shape they were before the incident. Surely with such a profusion of immune-system activity I would have experienced a vascular event. But, interestingly, within a couple of days of me experiencing the first symptoms my mother’s rheumatologist (who wasn’t even supposed to work on children, but he was all we had) got me a high-dose course of cortisone, which effectively treated my condition.
The immune system acting up, inflaming the blood vessels, including those that go to the brain, is the primary cause of silent strokes in the context of both me and my mother (assuming, that is, that we actually had them), and it just so happens that corticosteroids are anti-inflammatory and immunosuppressant. Huh. In hindsight the steroids probably prevented me from having a silent stroke that particular time, which, considering the severity of my reaction, might have been a rather bad one, perhaps even escalating to a not-so-silent mini-stroke (or something even worse than that!). We all knew I was in trouble, but in retrospect I might have been in extreme danger!
I also can’t help but think of a young person I know who also had a severe allergic reaction to penicillin, but at the age of 1, far younger than I was, and who regressed in development as a result, to the point they didn’t speak a word again for years, and ultimately was diagnosed with fairly severe autism, only being able to work up to being high-functioning in the teens, with the primary deficit being in speech. They do have the classic “stimming” behavior and the like, but the presentation, being normal until an allergic event (which is also an immunological event…) and only then contracting what resembled autism, is very strange, being overall more reminiscent to me of a stroke than autism (perhaps they had mild autism to begin with but then got the stroke on top of that and the latter was mistakenly ascribed to the former?). A cautionary tale of what might have happened to me if I was much younger and/or didn’t get the steroids quickly? I hope not…
Anyway, corticosteroids as a prophylactic against silent stroke in children is speculative medicine to say the least, but in the context I describe, where the underlying cause is autoimmune inflammation, it should work, at least theoretically. I find it very interesting that the three times I was in a situation that could bring on silent stroke the two times I got the symptoms of it were precisely the times I was not taking corticosteroids for the incident.
My family and personal history might be considerably more exotic and stroke-prone than yours, but if any of this sounds remotely familiar to you I’d advise you to read up on the signs and symptoms of a silent stroke, and perhaps, assuming it’s feasible, even get an expert in silent strokes to take an MRI or CT of your brain. These events are a lot more common, and their cumulative effects more deleterious, than is generally appreciated.