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Hello, Please See The Enclosed Reports For My Mother Which

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Posted on Tue, 2 Mar 2021
Question: Hello, please see the enclosed reports for my mother which is 88 years old. She fell and had to go in to the hospital this past weekend and since she has been home yesterday she was doing pretty good. But, what concerns me at night she is hollering in her sleep and shouting out people names and moaning like she is in severe pain and cannot get comfortable no matter what I do for her. She had a stroke back 2 years ago but has been doing ok since then. What concerns me though is this morning she got up very happy no problem moving around and was given her Synthyroid and 1/4 of her Seroquel which is 50 mg that we are weaning her off of. Please keep in mind when she went in the hospital she did not have Seroquel for 2 days and then she was given it when she got home which probably was a mistake. She went from being active and ok acting to not being able to pick her silverware to feed herself and wanted to be fed like a baby and grabbing food with her fingers which is something that she would NEVER do. I'm very concerned with what could be going on. I'm wondering if the Seroquel is causing this because she acting like her brain is not responding to her body right now and she was extremely sleepy after taking medicine. She had her medicine at 8:15am and around 11:45 am is when we noticed these actions. What do you think could possible be going on with her and what should I do? I think she is sun downing at night but I don't know if that is possible and what could have caused this and what can I do to stop this? She tosses and turn and hollers on and off throughout the night. She also said she is having a hard time concentrating and putting her thoughts together and her speech is a little different when coming out as well. She does have Dementia so she's on Donepezil.
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Follow up: Dr. Dr. Erion Spaho (10 minutes later)
I am trying to send you a copy of the reports but the system will not allow me to upload them. Is there another email address that I can upload them to?

The MRI Brain without Contrast showed: IMPRESSION:
1. No acute intracranial hemorrhage , mass effect, midline shift, hydrocephalus, or acute/subacute transcortical infarct.
2. Chronic small vessel disease, volume loss, and old cerebellar hemispheric infarcts are unchanged compared to CT head from yesterday.

CT HEAD OR BRAIN WITHOUT CONTRAST: IMPRESSION:
Volume Loss and small vessel disease. No intracranial hemorrhage or territorial infarction. Old ischemic infarcts are scattered as described.

What does all this mean in layman terms???? The report says more than what I typed of course, but this is what's listed under IMPRESSIONS.

Thanks!


doctor
Answered by Dr. Dr. Erion Spaho (1 hour later)
Brief Answer:
Probably new symptoms due to concussion. I would explain as follows.

Detailed Answer:
Hello and welcome to the " Ask a Doctor" service.

I have read your query.

I need to clarify one thing if the CT scan or the MRI were performed AFTER the fall or not.

If there is brain imaging evidence after the fall, then there is no severe traumatic brain injury that may justify these new symptoms.

If these imaging studies were performed before the fall, a new CT scan is necessary to exclude any brain injury.

However, in the setting of dementia and previous strokes, the brain is more susceptible and a minor fall may result in significant concussion symptoms.

On the other hand, returning to the use of antidepressants may also contribute to these neurological fluctuations.

In conclusion, in other words, the MRI and CT scan reports conclude that there are no new brain damages related to trauma, volume loss is indicative for dementia and past strokes are linked mainly with high blood pressure.

I think that some sleep pills for a short time ( clonazepam, melatonin, mexazolam, etc.) may help with these new issues.

Discuss with the Neurologist these issues.

Hope you found the answer helpful.

Let me know if I can assist you further.
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Dr. Erion Spaho (5 hours later)
Dr. Spaho,
Thanks for your prompt response. No one ever informed me that my mom had a concussion. Yes, the CT / MRI was performed after the fall. ALSO, when she is hollering and moaning she is actually calling out the names of her deceased sisters to help her. Does this mean anything to you? WHY is she eating food with her fingers and totally ignoring the silverware? SHE WANTS TO BEND HER HEAD OVER IN THE PLATE AND USE HER MOUTH TO PICK THE FOOD UP. ALSO, DOES THE SAME THING WITH HER COFFEE. WHY IS THIS HAPPENING? AND, WILL SHE GO BACK TO NORMAL EATING? SHE KEEPS HER HANDS DOWN IN HER LAP LIKE SAYING FEED ME WHILE REFUSING TO USE THEM AT ALL. THIS IS NOT MY MOM DOING THIS. As of tomorrow she will not be given anymore seroquel at all! How long do you think these symptoms will last? If melatonin is given, how many milligrams should we give her? Also, when she went in the hospital on the 6 of February she had to take a COVID19 test which was negative but they had no rooms for patients so they had to keep them in hallways etc. I'm worried that maybe she was exposed to COVID. When is the soonest, I can take her to have a COVID TEST? OR do you think it's necessary?
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Follow up: Dr. Dr. Erion Spaho (4 minutes later)
Do you think the seroquel is causing this? Please answer all my questions when you respond. I'm very disturbed over what's going on with her. She's old but she's tough as a box of nails...... I just need her back strong and healthy again. It's there any suggestions on daily vitamins or tonics that I can give her to build her immune system that you know of?

Thanks for everything
doctor
Answered by Dr. Dr. Erion Spaho (16 hours later)
Brief Answer:
our questions answered below.

Detailed Answer:
Hello again.

Since the CT/MRI were performed after the fall, you should not be worried more than necessary about significant brain injury.

The worsening of the cognitive status may be linked to concussion and should improve in a couple of weeks.
Seroquel use also may affect the cognitive tasks, I think after stopping it there should be a gradual improvement.

Since there are no typical symptoms for COVID-19 infection and your mother was tested for it, for now, it is not necessary another test.

Melatonin may be started at 10 mg/ in the evening and can be increased gradually at 50 mg/daily if necessary.

Hope this helps.

Take care.
Note: For further follow up on related General & Family Physician Click here.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
Answered by
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Dr. Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 4502 Questions

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Hello, Please See The Enclosed Reports For My Mother Which

I am trying to send you a copy of the reports but the system will not allow me to upload them. Is there another email address that I can upload them to? The MRI Brain without Contrast showed: IMPRESSION: 1. No acute intracranial hemorrhage , mass effect, midline shift, hydrocephalus, or acute/subacute transcortical infarct. 2. Chronic small vessel disease, volume loss, and old cerebellar hemispheric infarcts are unchanged compared to CT head from yesterday. CT HEAD OR BRAIN WITHOUT CONTRAST: IMPRESSION: Volume Loss and small vessel disease. No intracranial hemorrhage or territorial infarction. Old ischemic infarcts are scattered as described. What does all this mean in layman terms???? The report says more than what I typed of course, but this is what's listed under IMPRESSIONS. Thanks!