Question: My mother is 74 years old and has been facing irregular blood pressure and low heart beat. The blood pressure used to be high (140-90 or 140-100) and she was under medication using Telma 20. Later she started having very low blood pressure and low heart beat ( around 60) and she stopped medicine. After one week this caused her blood pressure to rise to very high level of 190-120. On restoring medication, bllod pressure returned to normal. She had also had three episodes of fainting for few minutes in last one year.
Her ECG and Echo Cardiogram were normal. Also in last six months two times 24 hours Holter study was done which was normal. Bllod test normal except for very high ESR at 49 and high Vitamin B12 of 1804.

A Brain MRI was also ordered. Brain MRI has revealed as under.

1. Brain MRI finding suggesting of few supra tentorial areas of chronic ischemic foci with diffused cerebral atrophy.
2. Brain MRI study reveals few discrete areas of T2/ fast flair hyper intense foci seen in balateral cereventricular and right basal ganglia suggestive of few chronic ischemic foci.
3. Rest of cerebral hemisphere shows diffused age related atrophy as evident by prominent cortical sulci, bilateral sylvian fissure and other sub-arachnoid spaces.
4. Supra tentorial system is prominent.
5. Brain stem, pitutory gland is normal.
6. Conclusion: Pl. Correlate Clinically.

Request advise on diagnosis and suggested line of treatment.

Thanks
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