Suggest Treatment For High BP And Mild Hydrocephalus

Posted on Thu, 25 Jun 2015

Question: My sister was diagnosed for high blood pressure and mild hydrocephalus. Her doctor is treating her mild hydrocephalus with drugs. Other blood test normal, bp fluctuates, LDL high and HBA1c high. Her first CT angio shows areas of vasospasm in the left, I am attaching her CT report for your reference. She is given paracetamol, IV dynastat 40mg, nimatop 60mg, nexium 40mg, rocephin, maxalon and dilantin. Her blood pressure still fluctuating. Would like any expert suggest opinion on her diagnosis and treatment. Thank you so much.

Answered by Dr. Dr. Muhammad Sareer Khalil (39 minutes later)

Brief Answer:
Sub Arachnoid hemorrhage

Detailed Answer:
Hello and Welcome

I appreciate your concern

I read the reports you uploaded. Your sister had a SAH ( Sub Arachnoid Hemorrhage ) which is the sudden onset of bleeding into the subarachnoid space in the meninges covering the brain.

The drugs that you stated are being prescribed correctly. Maintenance of systolic B.P in the range of 110 to 160 is crucial as pressure higher than this can lead to more bleeding.

Seizure prevention through dialantin and nimodipine to lower blood vessel spasm for prevention of subsequent stroke are being given which is the correct approach.

Angiography was done to look for the bleeding site which was the posterior fossa and to subsequently decide on surgical intervention e.g AVM clipping if any malformation is found , which according to your reports was not found. The hydrocephalus is mild and most likely shunting would not be required if it subsides. It may be indicated if its progressive. The decision has to be taken by the neurosurgeon/ interventional radiologist in this regard.

Wishing you best of health

Thanks

Please consult your doctor before deciding on any further course of action.

For future follow up / correspondence you may ask me directly at the link given below

http://doctor.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=68107

Dr. M.S. Khalil

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Muhammad Sareer Khalil (54 minutes later)

Hello Dr XXXXXXX

We are still some concern regarding my sister. Even though, she is currently monitored for her blood pressure. Her blood pressure has been fluctuating. For the past few days, it was around 150/75 but today, it was at 175/90. Her blood glucose level is also slightly higher, together with her LDL and HBAc1. Can it be due to side effects from any of those drugs that she is taking? We kind of worried about her glucose level since we do have family history of diabetes in the family.

Answered by Dr. Dr. Muhammad Sareer Khalil (9 minutes later)

Brief Answer:
Explained

Detailed Answer:
Hello.

The blood pressure fluctuations are expected. Though the systolic range according to your reply is somewhat acceptable. The drugs that she is being given currently have no effect on acutely (i.e in the short term ) raising the HBA1C, LDL or blood glucose levels. Diabetes , atherosclerosis both are long term risk factors and could have contributed to the current event. But the blood sugar or the blood pressure should not be lowered too quickly as it can be counter productive at this stage.

Let me know if you have any query.

Thanks.

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar