Your Good Health: Weakness on one side sounds like a stroke

Dear Dr. Roach: I am an 84-year-old woman, and have always been a good walker. Three months ago, I fell down and could not get up from the floor. I was not in pain, but I could not move my right leg. I went by ambulance to the hospital, where X-rays and many other tests were done. It took me 32 days in rehab before I could walk again and was released.

All the doctors and nurses said that I did not have a stroke, but they did say that I have weak muscles on the right side of my body. Could you please tell me what “weakened muscles” means? What can I do to prevent another fall?

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S.S.

The sudden onset of weakness on one side of the body sounds very much like a stroke to me. There are very few other possibilities I can think of.

There are many causes of weakened muscles. One of the most common in the elderly is a deficiency in vitamin D. Vitamin D supplementation is recommended for the elderly with a low level, because weakness is so frequent a symptom.

However, the weakness should be symmetrical. Other systemic causes, such as neuropathies or degenerative neurological diseases, also are almost always symmetric. So I don’t understand why you have weakness on only one side if the hospital personnel are sure that you did not have a stroke. Sometimes, a stroke can be very subtle; however, a stroke that affects an entire side of the body should show up on an MRI scan.

Regular exercise, preferably supervised by a physical therapist, can be helpful in preventing falls. A visit from a home nurse to evaluate the safety of your home can help prevent another episode. Finally, having a device that allows you to call for help even if you can’t reach the phone can be life-saving. I recommended one for any person who has had a fall from which they could not rise.

Dear Dr. Roach: My precious 80-year-old husband recently died very suddenly. The doctor said he died of a type of heart failure called “broken heart syndrome.” What is this? Was there some care he did not receive? Was his heart fractured in some way? Could his death have been prevented? I am devastated.

G.R.

I am very sorry to hear about your husband. What usually is meant by “broken heart syndrome” is called Takotsubo cardiomyopathy. It looks very much like a heart attack, but it occurs in the setting of severe emotional or physical stress. It is much more common in women than in men. Is not due to blockages in the arteries of the heart, as a regular heart attack is, but rather is a form of sudden heart failure. Death

is uncommon from Takotsubo cardiomyopathy (only about four per cent). The cause is unknown.

It also is possible to have a rupture of the wall of the heart. This can happen as a result of a conventional heart attack, but it also can happen in people with very severe heart failure, in which the heart muscle is stretched and thinned. I doubt this was the cause in your husband, as he most likely would have been very ill for a long time prior.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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