Brief Answer:
Recurrent infarcts, unless on proper treatment,can have bad prognosis.

Detailed Answer:
Hi XXXX,
Thanks for being here on healthcaremagic.com.
I am Dr.Ajay Panwar, a neurologist,here to answer your query.

I have gone through your dad's MRI report.

Your dad is having acute(left MCA territory) as well as chronic infarct(right MCA territory) with periventricular ischemic changes.That actually means he is prone to have recurrent infarcts.Recurrent infarcts carry bad prognosis in terms of increased chances of getting future infarcts,which may render the patient with permanent residual deficits or permanent paralysis.He needs to be properly investigated and put on regular treatment to prevent future complications.

Few important points here-
1)If he is a smoker,he needs to stop it.
2)If he is a hypertensive or Diabetic,he needs to have proper treatment and proper control for both these illnesses.
3)If he is a cardiac patient,he needs to be on regular cardiac medicines.

Important investigations to be done-
1)Blood sugar-fasting and post prandial to rule out Diabetes.
2)Lipid profile
3)ECG and Echocardiography
4)Bilateral Carotid Doppler

Treatment he must continue-
Tab.Ecosprin
Tab.Atorvastatin

Other medicines depending on his comorbidities and results of investigations.

ALL MEDICINES TO BE TAKEN UNDER THE SUPERVISION OF A NEUROLOGIST OR PHYSICIAN.

Hope,I have answered your queries.If you have some follow-up questions,I shall be glad to answer them,else please close the thread-rate it and write a review.

Dr.Ajay Panwar,
MD,DM(Neurology)

---

Brief Answer:
Control of BP.Aspirin and statins.Regular physiotherapy and speech therapy.

Detailed Answer:
Hi,
Thanks for being in follow-up.

As I said,His hypertension needs to be controlled well, as it is the biggest culprit in causing recurrent infarcts.
For now with the MRI report,I can say that whatever has happened,has happened:the best we can do in this situation is starting -
Tab.Ecosprin and Tab.Clopidogrel(dual antiplatelets in case of recurrent infarcts)as soon as possible(asap).
Tab.Atorvastatin as asap.
Tab.Coversyl plus.

Regular physiotherapy and speech therapy.
Following this management scheme regularly,we have to wait for the time(may be months) so that he gradually recovers from his deficits.

I hope it helps you.If still further questions,I shall be glad to answer,else please close the thread-rate it and write a review.

Dr.Ajay Panwar,
MD,DM(Neurology)

---

Brief Answer:
Prescription is ok.He will slowly recover.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
Prescription is Ok.But I feel the need to add on-
1)Tab.Clopitab(though ecosprin is there in the prescription,but since he is having recurrent infarcts,he needs double antiplatelet therapy)
2)Tab.Pantocid-to prevent drug induced gastritis.

DISCUSS YOUR PHYSICIAN ABOUT THESE ADD-ONS.

Your pertinent answers:
1)Yes,acidity will be a problem,hence I suggested to add pantocid.
2)He can be admitted for observation,especially in the initial 7 days of acute event to prevent any complication.
3)No surgery
4)It's not permanently curable but preventable,so it's important to be on regular medicines for lifetime because as the age increases,the risk of getting future infarcts increase.
5)I can understand the depression factor associated with homely issues along with the disease itself.He can be put on antidepressants(amitriptyline) for a couple of months.He needs a pleasant atmosphere where other persons around him does not create stressful enviornment.A psychiatrist may be of help or a clinical psychologist.Basically,the aim is to keep him mentally engaged(so people need to talk to him,the talks of his interest) and happy.
6)The treatment I mentioned above is all you have to ensure that he takes regularly for his life time.No casual attitude about this will do.If he skips medicines,he may have to pay a heavy price for it.I hope you have got it.Only time will tell,how much he will recover.Recovery may be 50%,may be 60,may be 70,80,90 or 100-only time and God knows.
7)'college' for 'car' and 'jeep' for 'syrup' is paraphasia-a kind of language disturbance due to infarct in the language area.It will improve with time.Speech therapy will recover it faster.

Hope,I have answered your queries.If you have some follow -up questions,I shall be glad to answer,else please close the thread-rate it and write a review.

If you ever want,you can send me a direct query at my HCM link-
http://doctor.healthcaremagic.com/doctors/dr-ajay-panwar/69273

Dr.Ajay Panwar
MD,DM(Neurology)

---

Brief Answer:
It is just Echocardiography scan. It rules out any cardiac cause for infarct.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up and you are welcome for the day.
This is a 2-dimensional Echocardiography report that is normal. It means that there are no cardiac (heart) abnormalities or heart disease that is causing this illness.

Otherwise also, in old age, age related atherosclerosis changes in blood vessels and long term effects of Hypertension on brain circulation vessels are more important causes(and these are also the reasons for your father's strokes) than the cardiac causes. After about 3-4 days of an acute infarct, blood pressure should be targeted below 120/80 mm hg. (Please be under supervision of your treating physician).
Hypertension, in long term, narrows down the diameter of the lumen of vessels carrying blood to the brain and as a result there is poor perfusion. Sometimes, narrowing gets to that extent that these vessels get completely blocked, thus causing stroke. That’s what has happened in your case.

This report is of Echocardiography and old report was of MRI, so no comparisons between this and the old report.


Hope, I have answered your queries. If you have some follow -up questions, I shall be glad to answer, else please close the thread-rate it and write a review.

If you ever want, you can send me a direct query at my HCM link-
http://doctor.healthcaremagic.com/doctors/dr-ajay-panwar/69273

Dr.Ajay Panwar
MD,DM(Neurology)

---

Brief Answer:
Regular physiotherapy and speech therapy is must.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.
Your pertinent answers-
1)Regular medicines, Regular physiotherapy and speech therapy, target Blood pressure below 120/80 mm hg, stress free environment, attempts to keep him mentally engaged and happy-is all that you can do from your side to help him the best.
2) Please follow everything I mentioned above and that will be the best care for him.
3) Yes, he can, rather should go for a walk daily. As I already said, physiotherapy is must.

4) Diet low in saturated fats will be helpful. Please visit a dietitian so that he/she may help in forming a diet plan for him. In fact that should be the type of diet for any individual, not just him. Otherwise, there are no specific restrictions.
5) Yes, he should do his work, if he is able to do. It is very important for rehabilitation.


Hope, I have answered your queries. If you have some follow -up questions, I shall be glad to answer, else please close the thread-rate it and write a review.


Dr.Ajay Panwar
MD,DM(Neurology)

---

Brief Answer:
He should take it two times a day and not once.

Detailed Answer:
Hi XXXX,
Thanks for being in follow-up.

I confirm you that these medicines are not to be taken for just 1 month but life-long.If he stops them ever,risk of getting another stroke will increase.

Strozina plus has to be taken twice a day and not once.

This prescription is ok,but as I already said that it contains only single antiplatelet drug(clopidogrel 150),but since he is having recurrent infarcts,he needs to be on double antiplatelet drugs.'Ecosprin' needs to be added to this prescription.Also 'Ranitidine' or 'Pantoprazole' needs to be added to prevent drug induced gastritis.

PLEASE DISCUSS YOUR TREATING PHYSICIAN REGARDING THE TREATMENT CHANGES I SUGGESTED AND CONTINUE TREATMENT UNDER HIS SUPERVISION.

I hope it helps.If you have still further questions,I shall be glad to answer.

Dr.Ajay Panwar,
MD,DM(Neurology)

---