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Having Hallucination And Recovered. Suddenly Went Into Coma And Had Paralysis. Had Paralysis Before. MRI Done, Ecg Normal

Posted on Mon, 23 Sep 2013

Question: Hi Doc,
This is regarding my grand father who is 98 years old. He had no major complains related to his illness and were never on any medications apart from normal vitamin pills and homeopathy medicine. he just had a minor paralysis attack of left side about 15 years back.

Since some time he was having some hallucinations but always recovered in a day or two. But 3 days back he suddenly slipped into semi coma and some what left side paralysis. HE ONLY SAYS WORDS LIKE YES AND THAT TO VERY RARE. he feels ticking sensation.
I have attached the MRI Scan of him which is conducted in hospital as now i have admitted him.
Please go through the both mri report pages and please let me know how bad it is and is it treatable???
If yes than how long it will take and will by grandfather recover in time with the help of medicines in hospital? please let me know the chances of it.. Doc says heart and ecg is ok and pressure is getting a bit low due to some medication which is started. about 90 /50

please help me understand how to treat this..
Thanks.. reports attached

XXXXX

Answered by Dr. Praveen K Nath (41 minutes later)

Brief Answer:
Poor prognosis. Continue Physiotherapy.

Detailed Answer:
Dear Sir,

Wishing a speedy & complete recovery for your grand father.

I have seen the reports attached. As per details given by you, he is suffering with large right middle cerebral artery infarct with mild hemorrhagic transformations.

Mostly these patients are treated conservatively with anti-convulsants, anti-edema measures, antibiotics, LMWH (Low Molecular Weight heparin) & supportive treatments. Ventilation may be required in few cases showing deterioration in sensorium. For hypotension, cardiac consultation is required to rule out its causes.

In my experience, prognosis is not very good in large infarcts, especially in elderly. So it is impossible to say whether he would recover or not, and when. I would advise to continue with treatment in hospital along with physiotherapy.

Hope this addresses your concern. Let me know if I can assist you further.

Thanks & Regards
Dr. Praveen K Nath XXXXXXX Consultant Neurosurgeon

Above answer was peer-reviewed by : Dr. Mohammed Kappan

Follow up: Dr. Praveen K Nath (3 hours later)

Dear Doc,
Thankyou very much for your quick response.

Since I understand that large infarcts means brain tissue damage or dead tissue.. is there any treatment to revive such dead tissue? can medication help in doing the same?

Today 2 hour back I spoke to him and he replied my some questions in 1 or 2 words. But he was not able to open his eyes.. It was very satisfying to hear his response to my questions..

Currentky he is given some tablets and mainly Mannitol Kabi.. what is this used for? Is it to improve the damage tissue?

Thanks.
XXXXX

Answered by Dr. Praveen K Nath (1 hour later)

Brief Answer:
Not much can be done. Wait and watch.
Detailed Answer:
Dear XXXXX, It is nice to know that your grandfather is improving.

IV mannitol /kabimol is used to reduce brain oedema. No definite injection is there to reverse infarct. IV TPA injection is used only to reverse early infarcts.

Thanks

Above answer was peer-reviewed by : Dr. Mohammed Kappan

Follow up: Dr. Praveen K Nath (17 hours later)

HI Doc,

Thanks for all possible response.. My final query is that what impact will it cause on my grand father activity due to large right infract.. Will it affect the movements of hands or legs or any loss of activity...? Any sensation or feeling loss.. I am asking this because i dont want to see him handicapp

Today he did open his eyes for a while and talked to me in 1 or 2 words.. looks like his memory is bit ok as he knows the names and place.

Thanks and regards,

XXXXX

Answered by Dr. Praveen K Nath (21 hours later)

Brief Answer:
Stroke

Detailed Answer:
DearXXXXXX

Wishes for a speedy recovery.

Normally large right MCA infarct will cause left sided hemiplegia (weakness). His movements on the left side is going to affected. However with time and physiotherapy, the weakness can improve. That being said, no doctor can be able to predict the future outcome.

Few patients may remain in coma for long. But first & foremost thing is to make him survive this stroke. Later physiotherapy & medical management will continue for long to bring back his movements and activities to as normal as possible.

Hope this answers your concern.

Dr. XXXXXXX k XXXXXXX XXXXXXX consultant neurosurgeon

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Praveen K Nath (7 hours later)

Hey Doc,
Thankyou for clearing all my doubts.. Your answers were very much useful and provided clarity to my thoughts.

Now I understand that first my grand father has to recover from stroke and get fully in senses and then with physiotherapy and medication the left side would improve.
Ya currently there is no strength in left arm.. left leg is a bit ok.
Since he has a bit of fever he is givrn now magnex forte injection.. along with some high protein powder. mannitol has stopped. He opens his eyes but says he can't see.. Any idea why? Hope it improves.

Once again thanks a ton

Regards
XXXXX

Answered by Dr. Praveen K Nath (35 minutes later)

Brief Answer:
Keep it maintained.

Detailed Answer:
Hi Mr XXXXX

Mild fever / occasional altered sensorium /abnormal memory etc are normal in such patients.
Diminished vision may be there due to involvement of parieto occipital fibres which deal with vision pathways in brain.
Continue with antibiotics as advised by the doctor.

Thanks
Dr XXXXXXX k XXXXXXX

Above answer was peer-reviewed by : Dr. Mohammed Kappan

Follow up: Dr. Praveen K Nath (4 days later)

Dear Doc.
I am also worried a lot about myself. Since I know how bad my grandfather is suffering bec of this brain problem

Actually when I was about 14 years old, I got a bad hit on my centre skull. Since it was a pointed iron grill it did bleed a bit from outside. Later I took pain killer and some anticeptic medication and I forgot about this injury.
Later when I was around 16 or 17 years old I hot hit at the same part of skull ie centre but this time the impact was big. Since it was not pointed it did not bleed but it pained for some time and then it got ok.
Again my bad luck that I was walking through another iron gate and I got hit almost same nearby skull and it was also very big impact. This happened 2 years back. Now I m 31,of age.
I know I must consider myself very unlucky that it hurt me bad almost 3 times same place ie centre skull and very big the last 2 time.
Now after what happened to my grandpa I am very worries if there might be any thing wrong with me. I don't have any symptoms which I find abnormal neither I have any big medical problem. Just had jaundice and typhoid and dengue.

So please advise me whethrr I should forget everything and move on or have anything to worry about.
Thanks
Zubin

Answered by Dr. Praveen K Nath (32 hours later)

Brief Answer:
no need to worry

Detailed Answer:
Dear Mr XXXXX
Hello

Normally if you don't have any symptoms & no headache/vomiting etc you don't need to worry about old head injury.

May I suggest you to get your CT brain /MRI brain only to rule out any sequel of head injury, if CT brain was not done at that time.

If there is any gliosis due to old head injury, there is treatment available. So nothing to worry about.

Thanks
Dr Praveen K Nath XXXXXXX Consultant Neurosurgeon

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Praveen K Nath (2 days later)

Dear doc,

My grandfather is doing ok currently and is trying to lift his hands and feet.
Just looking at him I feel he is not able to open his eyes for a long time. I mean he feels week from inside. Anything I can do about it?
He also speaks when he wants to or else he is just in his world and only replies in 1 word.

Could u suggest any tonic or suppliment to make him feel energetic
Thanks.

Answered by Dr. Praveen K Nath (18 hours later)

Brief Answer:
continue the instructions

Detailed Answer:
Dear mr XXXXX

Good to hear about your grandfather's progress & recovery.

Continue with the advice given by your doctor. Continue with physiotherapy & mobilization out of bed.
continue with feeding etc as advised.

there are few medications like CITICHOLINE/MEGACHOLIN / methylcobalamine for speedy recovery of cognitive functions etc . you can discuss with your doctor about the same.

my wishes for a speedy recovery
thanx
dr XXXXXXX k XXXXXXX XXXXXXX consultant neurosurgeon

Above answer was peer-reviewed by : Dr. Shanthi.E