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Suggest Treatment For Difficulty In Swallowing, Memory Issues And Dehydration
Question: having been taken into emergency treatment for dehydration and arrhythmias elevated extremely high left with swallowing difficulties and less memory. Healthcare magic advised MRI scan. Hospital say no acute neurological issues, fail to explain swallowing difficulties just refer to as dementia related. I do not feel it is dementia related as suffering numerous infections at the time and hot weather and ill health, compromised systems and age resulted in this problem. Should I look at MRI scan still or accept this weak explanation from the people who misdiagnosed need for warfarin and continued list of failures etc. in the first place? Why are the doctors not giving aripiprazole regularly and lorazepam for obvious distress and anxiety? not contraindicated. thank you
Brief Answer:
Detailed answer below
Detailed Answer:
Hello dear,
I have gone through your question and understand your concerns.
Memory impairment can be age related or secondary to some metabolic causes.
Dysphagia may be a part of brain involvement by dementia, Parkinson's, cranial nerve involvement.
Mri brain helps in looking for any structural lesions and involvement of various part of brain thus helping in arriving at a diagnosis.
Other workup required for dementia is blood sugar, Thyroid profile, vitamin B12, urea, creatinine.
Infection, arrhythmia, urinary tract infection are acute events requiring proper management and treatment.
Warfarin is indicated for prophylaxis for stroke in case of arrhythmia.
You can have a neurologist consultation for clinical diagnosis and need for Mri brain at this moment.
Anxiolytics can be given for prolonged continous period if stress is really troublesome.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Neurologist
Detailed answer below
Detailed Answer:
Hello dear,
I have gone through your question and understand your concerns.
Memory impairment can be age related or secondary to some metabolic causes.
Dysphagia may be a part of brain involvement by dementia, Parkinson's, cranial nerve involvement.
Mri brain helps in looking for any structural lesions and involvement of various part of brain thus helping in arriving at a diagnosis.
Other workup required for dementia is blood sugar, Thyroid profile, vitamin B12, urea, creatinine.
Infection, arrhythmia, urinary tract infection are acute events requiring proper management and treatment.
Warfarin is indicated for prophylaxis for stroke in case of arrhythmia.
You can have a neurologist consultation for clinical diagnosis and need for Mri brain at this moment.
Anxiolytics can be given for prolonged continous period if stress is really troublesome.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Yogesh D
Thank you for your help. The hospital have refused to give an MRI scan or to allow me to go privately to have one. They say not in the patient's best interests.
Their immediate answer is not able to conclusively say why dysphagia, neck swollen. They say dementia is the cause after the CT scan proved nothing.
I feel an MRI scan appropriate to get diagnosis and this would then provide the highest quality care. The hospital refuse. I have LPA. They want capacity test but as I have LPA then I should make decision. Clinically, would you advise just write off to dementia or go for MRI scan? Thank you.
Their immediate answer is not able to conclusively say why dysphagia, neck swollen. They say dementia is the cause after the CT scan proved nothing.
I feel an MRI scan appropriate to get diagnosis and this would then provide the highest quality care. The hospital refuse. I have LPA. They want capacity test but as I have LPA then I should make decision. Clinically, would you advise just write off to dementia or go for MRI scan? Thank you.
Brief Answer:
Can get Mri brain done.
Detailed Answer:
Hello dear,
I have gone through your question.
Dysphagia in true sense may be associated with nasal regurgitation or feeding difficulty, weight loss.
One possibility, if you have dysphagia with visible neck swelling may be Ludwig angina.
Acute dysphagia with nasal regurgitation with cardiac arrhythmia may be found in brainstem stroke requiring MRI brain imaging.
It's difficult to rationalize Mri without actual examination of patient.
If you can get it, that's not harmful.
If possible upload any case summary or prescription record for better assessment.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Can get Mri brain done.
Detailed Answer:
Hello dear,
I have gone through your question.
Dysphagia in true sense may be associated with nasal regurgitation or feeding difficulty, weight loss.
One possibility, if you have dysphagia with visible neck swelling may be Ludwig angina.
Acute dysphagia with nasal regurgitation with cardiac arrhythmia may be found in brainstem stroke requiring MRI brain imaging.
It's difficult to rationalize Mri without actual examination of patient.
If you can get it, that's not harmful.
If possible upload any case summary or prescription record for better assessment.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
As there have been a number of falls within a matter of a week prior to and including the day of discovering the infections and virus leading up to the bed bound 2 weeks and hospitalisation for a further two weeks. There has been no explanation given by hospital staff for this nor the dysphagia.
I think this justifies an MRI scan.
Hospital staff ignore this and say physiotherapy which he cannot undertake.
He may have injured himself especially as he fell backwards in the kitchen and hit the back of his head on the floor and XXXXXXX his back, according to him, the day before he went off his feet.
Again could this be a contributory factor? This would also justify an MRI scan wouldn't it? Hospital refuse him still saying not in his best interests.
I think this justifies an MRI scan.
Hospital staff ignore this and say physiotherapy which he cannot undertake.
He may have injured himself especially as he fell backwards in the kitchen and hit the back of his head on the floor and XXXXXXX his back, according to him, the day before he went off his feet.
Again could this be a contributory factor? This would also justify an MRI scan wouldn't it? Hospital refuse him still saying not in his best interests.
Brief Answer:
Get a neurologist consultation and Mri brain
Detailed Answer:
Hello dear
If the CT head was done after the episodes of fall and is normal then possibility of fall related subdural or extra dural hemorrhage is negligible.
In view of infection and complains of dysphagia an Mri brain contrast study and CSF study if indicated may not be useless.
Possibility of some structural lesion is less likely but it's better to get Mri to rule out any central cause of dysphagia.
What is the present status and disability.
What he is able to do and what not.
Any reports or case summary /discharge summary provided by hospital.
Do get back to me for further queries.
Regards
Dr Neeraj Kumar
Neurologist
Get a neurologist consultation and Mri brain
Detailed Answer:
Hello dear
If the CT head was done after the episodes of fall and is normal then possibility of fall related subdural or extra dural hemorrhage is negligible.
In view of infection and complains of dysphagia an Mri brain contrast study and CSF study if indicated may not be useless.
Possibility of some structural lesion is less likely but it's better to get Mri to rule out any central cause of dysphagia.
What is the present status and disability.
What he is able to do and what not.
Any reports or case summary /discharge summary provided by hospital.
Do get back to me for further queries.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Yogesh D
Hospital say medically fit for discharge but will not discharge.
Cannot walk.
Cannot swallow, even puree food difficult to swallow, impaired memory compared with previous memory, confused but environment is contributing to this, psychiatric medication is completely messed up form his previous regime and has become hostile, aggressive almost hitting a nurse yesterday, because of fear and frustration, was not given lorazepam 0.5 mg to calm him (usual regime and can have up to 2 mg a day, staff say given aripiprazole as it was signed for but I do not believe this because he is not aggressive if received it,) He was supposedly given aripiprazole 7.5 mls on Sunday night at 8pm and 8pm on Monday morning. He usually has it every morning at 8am so this was very closely dispensed time wise. He has difficulty with using correct words, never before like this, sight poor hating bright light or sunlight etc. Poor dietary in take and fluid intake, now puree consistency and low potassium levels. poor sleep pattern. Please advise.
Cannot walk.
Cannot swallow, even puree food difficult to swallow, impaired memory compared with previous memory, confused but environment is contributing to this, psychiatric medication is completely messed up form his previous regime and has become hostile, aggressive almost hitting a nurse yesterday, because of fear and frustration, was not given lorazepam 0.5 mg to calm him (usual regime and can have up to 2 mg a day, staff say given aripiprazole as it was signed for but I do not believe this because he is not aggressive if received it,) He was supposedly given aripiprazole 7.5 mls on Sunday night at 8pm and 8pm on Monday morning. He usually has it every morning at 8am so this was very closely dispensed time wise. He has difficulty with using correct words, never before like this, sight poor hating bright light or sunlight etc. Poor dietary in take and fluid intake, now puree consistency and low potassium levels. poor sleep pattern. Please advise.
Brief Answer:
Consult a neurologist, may take second opinion if unsatisfied
Detailed Answer:
Hello dear,
He may be having delirium along with dementia.
These findings may be age related but delirium is usually secondary to some infection or metabolic cause. uncommonly patient may develop ICU psychosis due to prolonged hospital stay.
If all reports are normal, Mri brain can be done.
Some improvement may take some time.
Reversal of sleep wake cycle, irritable condition and impairment in consciousness are matter of concern.
Patient may require some more time for hospitalisation if reports are abnormalą„¤.
If all reports are normal then some time in home with drugs can be tried.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Neurologist
Consult a neurologist, may take second opinion if unsatisfied
Detailed Answer:
Hello dear,
He may be having delirium along with dementia.
These findings may be age related but delirium is usually secondary to some infection or metabolic cause. uncommonly patient may develop ICU psychosis due to prolonged hospital stay.
If all reports are normal, Mri brain can be done.
Some improvement may take some time.
Reversal of sleep wake cycle, irritable condition and impairment in consciousness are matter of concern.
Patient may require some more time for hospitalisation if reports are abnormalą„¤.
If all reports are normal then some time in home with drugs can be tried.
Hope you found the answer helpful.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Please, what is an ICU
Brief Answer:
ICU is intensive care unit
Detailed Answer:
Hello dear,
ICU is intensive care unit.
Actually some patients with prolonged hospitalisation in intensive care unit or HDU (high dependency unit) with lots of monitor and there beeps suffer ICU psychosis leading to delirium.
Such patients recover early in home or normal wards.
Hope this answers your query adequately.
Regards
Dr Neeraj Kumar
Neurologist
ICU is intensive care unit
Detailed Answer:
Hello dear,
ICU is intensive care unit.
Actually some patients with prolonged hospitalisation in intensive care unit or HDU (high dependency unit) with lots of monitor and there beeps suffer ICU psychosis leading to delirium.
Such patients recover early in home or normal wards.
Hope this answers your query adequately.
Regards
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Shanthi.E
Many thanks yes, it does answer my questions. Your expertise has been invaluable. I still have a fight on my hands to get the care and treatment but you have given me a far superior explanation and understanding of a complex situation and health care need.
When reviewing, my computer does not show rating stars so I have to go to your home page. Please rest assured, that I feel that top rating will be give. Again, thank you so much for the care and professionalism you helped us and your expertise and knowledge excellent.
With regards, XXXX
When reviewing, my computer does not show rating stars so I have to go to your home page. Please rest assured, that I feel that top rating will be give. Again, thank you so much for the care and professionalism you helped us and your expertise and knowledge excellent.
With regards, XXXX
Brief Answer:
THANKS FOR YOUR KIND WORDS
Detailed Answer:
Hello dear,
Thank you for your kind words.
As a doctor we try to treat the patient and help there care giver to tide over such a medical situation as it is unplanned, unwelcomed situation.
We will lend you best possible helping hand and remaining rest on God.
May God bless you.
Thanks
Dr Neeraj Kumar
Neurologist
THANKS FOR YOUR KIND WORDS
Detailed Answer:
Hello dear,
Thank you for your kind words.
As a doctor we try to treat the patient and help there care giver to tide over such a medical situation as it is unplanned, unwelcomed situation.
We will lend you best possible helping hand and remaining rest on God.
May God bless you.
Thanks
Dr Neeraj Kumar
Neurologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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