
Hi, I Am 39 Years Old Female. With History Of


DSA would help in further decision making.
Detailed Answer:
Hi,
Thank you for posting your query.
I am Dr Sudhir Kumar, Neurologist, and would try my best to help you.
I have noted your clinical and MRI/MRA details of last year as well as this year's.
Diabetes and hypertension are well known risk factors for brain stroke. In such cases, antiplatelets and statins are sufficient for preventing stroke recurrence (you are already on these medicines). In addition, strict BP and sugar control are needed, which you are already doing.
Regarding stenting, it is not needed, if there is 100% stenosis. For stent to be successful, the blockage should be less than 100%. Sometimes, MR Angiogram reports are not accurate. The gold standard is DSA- digital subtraction angiography of cerebral vessels, which would give clearer picture regarding three things- 1. Whether the occlusion is 100% or less, 2. Whether there are adequate collaterals, 3. To rule out cerebral vasculitis.
In young strokes, we need to exclude vasculitis as a cause of stroke, where DSA can help. This is more important, as a clear-cut cause has not identified for your stroke (except for sugar and BP).
I sincerely hope my reply has helped you.
I would be pleased to answer, if you have any follow up queries or if you require any further information.
Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/

DSA would help in further decision making.
Detailed Answer:
Hi,
Thank you for posting your query.
I am Dr Sudhir Kumar, Neurologist, and would try my best to help you.
I have noted your clinical and MRI/MRA details of last year as well as this year's.
Diabetes and hypertension are well known risk factors for brain stroke. In such cases, antiplatelets and statins are sufficient for preventing stroke recurrence (you are already on these medicines). In addition, strict BP and sugar control are needed, which you are already doing.
Regarding stenting, it is not needed, if there is 100% stenosis. For stent to be successful, the blockage should be less than 100%. Sometimes, MR Angiogram reports are not accurate. The gold standard is DSA- digital subtraction angiography of cerebral vessels, which would give clearer picture regarding three things- 1. Whether the occlusion is 100% or less, 2. Whether there are adequate collaterals, 3. To rule out cerebral vasculitis.
In young strokes, we need to exclude vasculitis as a cause of stroke, where DSA can help. This is more important, as a clear-cut cause has not identified for your stroke (except for sugar and BP).
I sincerely hope my reply has helped you.
I would be pleased to answer, if you have any follow up queries or if you require any further information.
Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/

The earlier the better.
Detailed Answer:
Thank you for getting back.
COVID is a much minor illness, as compared to brain stroke. All over the world, people are advised not to delay management of stroke due to COVID pandemic. This is because stroke is disabling as well as fatal in some cases. I would advise against delaying DSA.
DSA is a safe procedure and it carries a risk of only 1-4% in good centers.
Regarding the future progression and treatment, it would be clear only after DSA. Any more advice (compared to what I gave last time) is not possible at this time.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

The earlier the better.
Detailed Answer:
Thank you for getting back.
COVID is a much minor illness, as compared to brain stroke. All over the world, people are advised not to delay management of stroke due to COVID pandemic. This is because stroke is disabling as well as fatal in some cases. I would advise against delaying DSA.
DSA is a safe procedure and it carries a risk of only 1-4% in good centers.
Regarding the future progression and treatment, it would be clear only after DSA. Any more advice (compared to what I gave last time) is not possible at this time.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)


thank you so much for the detailed explanation and suggestion for further investigation. I was supposed to travel to my native in April for further follow up check,however due to the covid this has been delayed. Since you suggested DSA, which was suppoed to be done in May, i was not able to do it till now. My cousin who is a doctor (neuro) in XXXXXXX suggests that i travel only once things settle down as the COVID cases in XXXXXXX and very high right now. Since i stay all by myself in XXXXXXX it is a little difficult to get this test done if it requires someone to be there with me. However, since it has been couple of months since we know there is complete occlusion, i want to know if this is very critical to be done right away, else i will wait till Sept to travel to XXXXXXX to get this done.
Also, I would like to know the complications related to this procedure and in patients like me what is the progression of this condition and what is the usual course of treatment and recovery/management.
If there is complete occlusion will i still be able to go on with my normal life and acitivites with the collatorals that are formed, or will it require some kind of intervention or procedure.
thank you in advance for your support.

thank you so much for the detailed explanation and suggestion for further investigation. I was supposed to travel to my native in April for further follow up check,however due to the covid this has been delayed. Since you suggested DSA, which was suppoed to be done in May, i was not able to do it till now. My cousin who is a doctor (neuro) in XXXXXXX suggests that i travel only once things settle down as the COVID cases in XXXXXXX and very high right now. Since i stay all by myself in XXXXXXX it is a little difficult to get this test done if it requires someone to be there with me. However, since it has been couple of months since we know there is complete occlusion, i want to know if this is very critical to be done right away, else i will wait till Sept to travel to XXXXXXX to get this done.
Also, I would like to know the complications related to this procedure and in patients like me what is the progression of this condition and what is the usual course of treatment and recovery/management.
If there is complete occlusion will i still be able to go on with my normal life and acitivites with the collatorals that are formed, or will it require some kind of intervention or procedure.
thank you in advance for your support.
It is an invasive procedure.
Detailed Answer:
They inject a XXXXXXX via a catheter. So, it is an invasive procedure. However, it is a well established procedure, it is routinely done and it is quite safe.
Let me know the reports of DSA, after you get it done.
Best wishes,
Dr Sudhir Kumar MD DM

It is an invasive procedure.
Detailed Answer:
They inject a XXXXXXX via a catheter. So, it is an invasive procedure. However, it is a well established procedure, it is routinely done and it is quite safe.
Let me know the reports of DSA, after you get it done.
Best wishes,
Dr Sudhir Kumar MD DM


Do they inject the XXXXXXX or is it with a catheter and do it ?

Do they inject the XXXXXXX or is it with a catheter and do it ?
Best wishes.
Detailed Answer:
Best wishes,
Dr Sudhir Kumar MD DM

Best wishes.
Detailed Answer:
Best wishes,
Dr Sudhir Kumar MD DM


Thank you for your timely advice and support.
Best regards
Nandini

Thank you for your timely advice and support.
Best regards
Nandini
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