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What Does My CT Scan Report Indicate?

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Posted on Thu, 1 Sep 2016
Question: My sister have been on Atripla and bactirm for over 15 months and her CD4 rises from 45 to 145 and again 134 down but there was no viral load test. Yesterday she checked her viral load somewhere after 15 months of atripla and bactrim her viral load is 184. Am I concerned because it should have been less than 50. During her 15 months atripla every time since morning she felt heavy head and in the afternoon totally she cannot even properly move her head too severe head ache she cannot move her head easily but she always take atripla at 9:00pm is it really the side effect of atripla?
She usually take Atripla at 9:00PM before bed and 1:00Pm after lunch bactrim. She had headache ofcourse before she start atripla but it was not severe. Then after she started atripla the headache started to emerge for sixth months then again especially in the last five or six month wow so horrible. When she took atripla at night she immediately fell asleep for two hours then sweating then in the morning feel good relatively less headache then it starts to grow then after 2:00PM she cannot even move her head very very heavy head headache. The doctor told her just keep it taking what you are taking because the change is slow just wait. But I'm not convinced that is why I am here asking you. She had job but due to this severe head ache for half a day she is not working for 15 months. Please help.
I attached it is a CT scan but I didn't understand the terms and also I'm scared exposing this excessive ray probably not good for her too.
doctor
Answered by Dr. Dr.Arnab (37 minutes later)
Brief Answer:
Follow the Advises..

Detailed Answer:
Hello xxxxxxx, Welcome to HCM,

I've gone through your query and understand your concern for your Sister,

First of all, I'm really sorry for all the inconvenience caused to you along with this delay, I'll try to solve it with as much as possible..

As you've rightly pointed out, with such a treatment course of Atriptla, not only the viral load is expected to reduce but also a generalized improvement in her overall physical status is expected..

No this headache is much severe than any usual drug induced side effects, and good that you've gone for the essential CT scan of the head..

I've gone through the CT-scan report dear, and you really shouldn't worry about the radiation exposure, as the benefit outweighs the risk here..

The CT scan showed hemorrhage(bleeding) in side Brain, which is 'non-traumatic'- means it's not due to any injury, 'unspecified' means the exact cause has yet to be specified for this..

All those difficulty in looking upwards, feeling excessively sleepy, abrupt sweating are classical symptoms in this conditions..

Now, the initial central nervous system examination was suspicious for ICSOL(Intra Cranial Space Occupying lesion), which, after discussing with Rediologist, has been confirmed as blood in side the brain and ventricles(cisterns in side the brain)..

There are several things missing in this CT, i.e. the exact location, size of the bleed, surrounding edema and pressure effects over other structures, they have to be diagnosed with further clinical examination and investigations..

Dear, she needs urgent medical attention and in patient admission in hospital under a Neurologist/Neurosurgeon who'll keep her monitoring, examine further, start her on anti-edema measures, as well as prophylactic anti-epileptics and further assess for any need for surgical intervention to reduce the pressure symptoms of the brain..

No she's not at all fit for any work now, as you can very well understand due to this severity of symptoms.. I couldn't see any date mentioned there in the scan, and if it's done more than 24 hrs back, then a repeat CT scan is required to see the current situation in side her brain..

Please don't delay any more and take her to your nearest ER/Urgent care along with the CT-reports and other details, from where she'll be promptly admitted and relevant investigations as well as management therapy will be initiated..

Let me know how she stays in the due course..

Let me know if your having any further queries, I'll be glad to clarify further..

Take Care of your Sister dear,
My Best Wishes
Kind Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Dr.Arnab (2 hours later)
Thank you Dr. XXXXXXX Banerjee for your brief explanation
She did CT scan just two days ago and the doctor told her to do again another CT scan and I am so much concerned this is too much exposing to this powerful ray again not good any way I got their comment and it says:

"After disscusion with radiology unit XXXXXXX residents the density is measured to be 183 Hounsfield and no evidence of blood except there is a granulomatous hike lesion on the right thohamic region and hence Brain CT scan to contrast is recommended (Neurologist also consulted). "

What will be the treatment options? and is it reversible? what are the possible drugs that can interact with the Atripla she is taking? thank you.
doctor
Answered by Dr. Dr.Arnab (1 hour later)
Brief Answer:
treatment course is prolonged, and extensive investigations required..

Detailed Answer:
Hello xxxxxxxxxxx, Welcome back,

Thanks for following up with these vital details,

Good to know that there's no blood as per your quoted description, but still confirmation can only be obtained after a proper thorough CT/MRI..

Once again, I'm reassuring not to worry about the "powerful ray", simply because the benefit of the investigation outweighs the risk here..

Yes, if it's a space occupying lesion other than than blood (I'd still not comment based on a non-contrast CT, if it's granulomatous or not, simply because it's not conclusive enough to comment on this yet)..

Yes, definitely a Contrast enhanced CT is required which will give a much clear idea to identify the nature of the lesion and any other associated pathology involved..share the complete reports with me once it's done so that I can give you more specific advice in that aspect..

If it's granulomatous then first of all tubercular origin must be ruled out as well as any related abscess and/ fungal infections and/ any other CNS tumor..

Treatment options mainly dependent on the findings..

Other than that, Primary care along with supportive measures like prophylactic anti-epileptics measures(specially since Thalamic region is involved), cerebral decongestants(if any raised intra cerabral pressure is suspected), analgesics, antibiotics etc. have to be continued..

Further investigations may be warranted including a lumbar puncture to analyse the Cerebro Spinal Fluid for any infection(tubercular or any other bacterial, fungal etc.)..

Each of these different etiologies have separate lines of specific treatment so, let them investigate firstly to diagnose the exact cause, then it'll be managed accordingly..

Reversibility depends on the findings dear, so let the exact cause to be found at first..

There's a huge list of drug-drug interaction for Atripla(at least 50 of them), which is unnecessary to know, as it'll only create more confusion.. I strongly believe her doctor is totally aware of them and treating her with the least interactive medication only, please have faith on her doctor, i do believe she's in good hands..

Let me know once further investigations are done, and their reports, i'll be glad to clarify further..

Let me know how she stays in the due course..

Take Care
Kind Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Dr.Arnab (17 hours later)
Thank you doctor for your fast reply I will write what the doctor will write tomorrow. Thank you.
doctor
Answered by Dr. Dr.Arnab (8 hours later)
Brief Answer:
You're always welcome to have my suggestions..

Detailed Answer:
Your Most welcome Dear

Yes I'll look forward to hear from you on the further proceedings ..

Best Wishes
Kind Regards
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Dr.Arnab (19 hours later)
Hello Dr,
I got the report and the prescription what is your comment? I attached the report and prescription.
doctor
Answered by Dr. Dr.Arnab (7 hours later)
Brief Answer:
appropriate treatment started, let me know how she's doing in your observation

Detailed Answer:
Hello Dear, Welcome Back,

Thanks for sharing the Repeat Contrast CT and the prescription, it seems there's some inflammation in side the brain and all those changes in the cisterns and mid-brain are secondary to that only..now the exact nature of the swelling (the intra cranial SOL) is not commented here, so may be needed further investigations like a lumber puncture for a complete CSF analysis to rule out infective causes (routine microscopy, gm stain, AFB, culture sensitivity),..

Right now she's been put on a tapering dose of steroids to reduce the swelling, which is appropriate, please ask the neurologist if they are planning to do CSF analysis after steroid therapy..

However, it's their decision when to do it, depending on her clinical improvement..

So far the treatment line is fine, let me know how she's doing in your observation..also discuss with the concerned Neurologist regarding the next step of management (if they're planning to do any further imaging subsequently)..

Let me know how she stays in the due course..any queries your having, feel free to ask, i'll be glad to clarify..

Take Care
Kind Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Dr.Arnab (10 minutes later)
Thank you doctor,
The doctor who treated her told that she will come again after two weeks nothing they disclose.
doctor
Answered by Dr. Dr.Arnab (6 minutes later)
Brief Answer:
follow-up consultation..

Detailed Answer:
Welcome back Dear,

Stay assured that they're doing the right things for her..

Normally no one discloses the types of management and further planning with the kin, but if you ask then they'll definitely tell you a brief overview of it..

Any way let the steroid therapy continue and observe how she's doing in general as well as neurologically, in case of any doubts feel free to ask me anytime, i'll be glad to clarify..

Take Care
Kind Regards

For future reference you can always get in touch with me, below is my direct follow-up link through which you can contact me anytime anywhere, I'll be happy to help -

http://www.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=71041

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Dr.Arnab (5 minutes later)
Thank you for your fast reply doctor,

What will be the next step after two weeks follow up of course it depends on the out come but could you please tell me the probably way of treating her in order to get healed?
doctor
Answered by Dr. Dr.Arnab (19 minutes later)
Brief Answer:
It depends from person to person..

Detailed Answer:
Welcome back Dear,

Dear, please try to understand that no one can predict the future, but still since she's in proper hands, receiving appropriate treatment, this should get controlled with the further course of the steroids..

Probable way is mostly conservative only(with the help of medication), unless there's any sudden onset neurological deterioration or no gross improvement in the overall status (which i believe, is not in this present scenario)..

Since I don't have the privilege to examine her clinically, I'll be needing a case summary which describes the total course of stay, investigations and management done during that phase in details, then I'll be able to describe the further details in the line of management..

I believe she's still admitted only, so you can simply ask for the Case summary to them, they'll provide you, with the help of that, even you can correlate a lot of events and off course it's extremely helpful for me to have a detailed systemic documented course in the hospital to determine at least some of the actions in the near future..

I sincerely hope you'll understand what I'm trying to explain here..

In case of any doubts feel free to ask me anytime, i'll be glad to clarify..

Take Care
Kind Regards

For future reference you can always get in touch with me, below is my direct follow-up link through which you can contact me anytime anywhere, I'll be happy to help -

http://www.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=71041

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
default
Follow up: Dr. Dr.Arnab (5 minutes later)
Thank you Dr.
I was not saying to predict the future but I gave as much detail as possible to get some clue. Anyway thank you for your help.
doctor
Answered by Dr. Dr.Arnab (5 minutes later)
Brief Answer:
You're always welcome to have my suggestions..

Detailed Answer:
Welcome Back Dear,

I've already given you as much as details possible to be provided in this short span of window so that you don't stay in the dark, but I need further information too to clarify further, please try to understand ..

I still think, you can simply ask for the Case summary to them, they'll provide you, with the help of that, even you can correlate a lot of events and off course it's extremely helpful for me also to have a detailed systemic documented course in the hospital to determine at least some of the actions in the near future..

I'm always here for help, in case of any doubts feel free to ask me anytime, i'll be glad to clarify..

Take Care
Kind Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Dr. Dr.Arnab

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Practicing since :2012

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What Does My CT Scan Report Indicate?

Brief Answer: Follow the Advises.. Detailed Answer: Hello xxxxxxx, Welcome to HCM, I've gone through your query and understand your concern for your Sister, First of all, I'm really sorry for all the inconvenience caused to you along with this delay, I'll try to solve it with as much as possible.. As you've rightly pointed out, with such a treatment course of Atriptla, not only the viral load is expected to reduce but also a generalized improvement in her overall physical status is expected.. No this headache is much severe than any usual drug induced side effects, and good that you've gone for the essential CT scan of the head.. I've gone through the CT-scan report dear, and you really shouldn't worry about the radiation exposure, as the benefit outweighs the risk here.. The CT scan showed hemorrhage(bleeding) in side Brain, which is 'non-traumatic'- means it's not due to any injury, 'unspecified' means the exact cause has yet to be specified for this.. All those difficulty in looking upwards, feeling excessively sleepy, abrupt sweating are classical symptoms in this conditions.. Now, the initial central nervous system examination was suspicious for ICSOL(Intra Cranial Space Occupying lesion), which, after discussing with Rediologist, has been confirmed as blood in side the brain and ventricles(cisterns in side the brain).. There are several things missing in this CT, i.e. the exact location, size of the bleed, surrounding edema and pressure effects over other structures, they have to be diagnosed with further clinical examination and investigations.. Dear, she needs urgent medical attention and in patient admission in hospital under a Neurologist/Neurosurgeon who'll keep her monitoring, examine further, start her on anti-edema measures, as well as prophylactic anti-epileptics and further assess for any need for surgical intervention to reduce the pressure symptoms of the brain.. No she's not at all fit for any work now, as you can very well understand due to this severity of symptoms.. I couldn't see any date mentioned there in the scan, and if it's done more than 24 hrs back, then a repeat CT scan is required to see the current situation in side her brain.. Please don't delay any more and take her to your nearest ER/Urgent care along with the CT-reports and other details, from where she'll be promptly admitted and relevant investigations as well as management therapy will be initiated.. Let me know how she stays in the due course.. Let me know if your having any further queries, I'll be glad to clarify further.. Take Care of your Sister dear, My Best Wishes Kind Regards