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Please help - Cardiac + Neuro case.

 
 
Reply Sat 14 Jun, 2014 01:37 pm
My Father is 60 years old. For over a month now he is partially unconscious, he is been experiencing this Post CABG and Post AVR after 19-May-2014. Doctors have informed that due to high amount of calcification on the Aortic valve during Valve replacement small plaques would have showered to the brain and hence this has caused the brain to not to function as normal. Cardiac doctors have referred to Neurologists and they have recommended for MRI Scan and it was done 21-May-2014 and 24-May-2014. Here are the details from the MRI reports.
Doctors currently are saying that it will take more than 6months for my father to recover. At this point of time he is partially opening eyes on his will. When we call him intermittently he opens eyes. Along with this he is having both the leg movements in the bed and left hand movements. Right hand reflections and movements are very slow. Kindly help me with any suggestion in this case and if anyone of you has come across any such cases please share your experience and process of treatment that was done. And if so, how much time did it take for those patients to completely recover.

DIFFUSION IMAGING:

TECHNIQUE:
DWI Axials.
SE T1 Axials.
FSE T2 Axials.
FLAIR Axials.
GRE Axials.
3D TOF for MR Angiography of intracranial arterial system.

FINDINGS:
Known case of CAD, post CABG status on 15/5/2014.

Ventricular system is normal.

Multiple punctate and patchy T2/FLAIR hyperintensities noted involving the bilateral caudate and putamen, thalami, bilateral cerebellar hemispheres, cortex and subcortical white matter of bilateral cerebral hemispheres. These lesions are hypointense on T1W images and show diffusion restriction.

Multiple foci of blooming noted in bilateral cerebral and cerebellar hemispheres on susceptibility weighed images.

Rest of the cerebral parenchyma shows normal signal characteristics.

Extracerebral CSF spaces are normal.

No evidence of extra axial fluid collections.

Rest of the brainstem and cerebellar hemispheres are normal

CP angles and internal auditory canals are normal.

MR Angiography of intracranial arterial system reveals normal calibre and flow in all the intracranial branches of anterior and posterior circulation. No evidence of focal stenotic / occlusive pathology.

Multiple subacute embolic infarcts in supra and infra tentorial compartments as described above.

***********************************************************************

MRI BRAIN:

TECHNIQUE:
DWI Axials.
SE T1 Axials.
FSE T2 Axials.
FLAIR Axials.
GRE Axials.
2D TOF / 3D PF For MR Venography of intracranial venous system.
3D TOF for MR Angiography of intracranial arterial system.

FINDINGS:
Known case of CAD, post CABG and post AVR status on 15/5/2014.

Ventricular system is normal.

Multiple punctate and patchy T2/FLAIR hyperintensities noted involving the bilateral caudate and putamen, thalami, bilateral cerebellar hemispheres, cortex and subcortical white matter of bilateral cerebral hemispheres. These lesions are hypointense on T1W images and show diffusion restriction.

Multiple foci of blooming noted in bilateral cerebral and cerebellar hemispheres on susceptibility weighed images.

Mild swelling / thickening of cortices of both frontal lobes.

Rest of the cerebral parenchyma shows normal signal characteristics.

Extracerebral CSF spaces are normal.

No evidence of extra axial fluid collections.

Rest of the brainstem and cerebellar hemispheres are normal

CP angles and internal auditory canals are normal.

MR Venogram of the intracranial arterial system reveals normal calibre and flow in the superior sagittal, transverse and sigmoid sinuses on both sides. Deep venous system shows normal flow.

MR Angiography of intracranial arterial system reveals normal calibre and flow in all the intracranial branches of anterior and posterior circulation. No evidence of focal stenotic / occlusive pathology.

Multiple subacute embolic infarcts in supra and infra tentorial compartments as described above.

Current medicines that are used:
TAB.AUGUMENTIN 625MG TID
TAB. STORCIT 5OOMG BD
TAB. NOOTROPHIL 1200MG TID
TAB. WARF 3MG OD
TAB. BETALC 25MG BD
TAB. AMLODEPIN 5MG
TAB. ROLES 20MG
TAB. FRUSELAC
TAB.BEPLEXFORTE
TAB.SPORLAC
TAB. ECOSPRIN 150MG
SYP. MUCAINEGEL 10ML
 
jespah
 
  6  
Reply Sat 14 Jun, 2014 01:41 pm
@kvdpraveen,
You need to get another opinion, from a doctor who will see your father in person.

I am sorry this is happening but this site cannot give out medical advice. And you shouldn't be looking for it online, either. No reputable physician would so much as attempt to diagnose your father without seeing the patient in person, and further, no reputable physician would even share similar stories in such detail (physician-patient privilege).

If you absolutely, positively, must look for this sort of information online, Google health sites and look for ones like WebMD that are staffed by doctors. But I repeat - no one can provide a diagnosis with any degree of accuracy unless they see your father, and anecdotal information, even from similar cases, is highly likely to be utterly meaningless.
Romeo Fabulini
 
  -1  
Reply Sat 14 Jun, 2014 01:58 pm
Hi, the only things I know about AVR (Aortic Valve Replacement) and CABG (Coronary Artery Bypass Graft) are from the internet, specifically-
"It usually takes about two to three months to make a full recovery from CABG, but this varies between individuals"

The doctors treating your dad seem to be pretty much on the ball, so it's just a waiting game for now, but getting a second opinion like Jespah said won't do any harm.
60 years of age is not old by todays standards, heck a 65-yr-old guy (Ranulph Fiennes) even climbed Everest after a heart bypass op and runs marathons..Smile

Useful links-
http://www.bupa.co.uk/individuals/health-information/directory/c/con-art-bypass-cabg
http://www.nhs.uk/Conditions/Aorticvalvereplacement/Pages/Recovery.aspx
kvdpraveen
 
  1  
Reply Sat 14 Jun, 2014 02:03 pm
@jespah,
Hi Jespah,
Thank you for taking some time and replying to me with your advice.
Sure I will try to take him to another doctor to get another opinion once he is discharged from hospital, as he is still admitted and treatment is going on.

Regards,
0 Replies
 
kvdpraveen
 
  1  
Reply Sat 14 Jun, 2014 02:10 pm
@jespah,
Hi Jespah,

I forgot to ask, can this happen due to lack of proper precautions taken during CABG and AVR surgery OR is this something unpredictable and unavoidable.

Regards.
jespah
 
  5  
Reply Sat 14 Jun, 2014 02:13 pm
@kvdpraveen,
You're still asking for medical advice.

I am not a doctor. And the vast, vast majority of people here aren't, either. This is like you throwing darts at a board, hoping to hit a diagnosis, or at least a doctor. Like I said, I am sorry this is happening, but this is no way to get the help for your father that he needs.
kvdpraveen
 
  1  
Reply Sat 14 Jun, 2014 02:20 pm
@jespah,
okay Thank you
0 Replies
 
kvdpraveen
 
  1  
Reply Sat 14 Jun, 2014 02:27 pm
@Romeo Fabulini,
Thank you Romeo for your advice.
0 Replies
 
Butrflynet
 
  2  
Reply Sat 14 Jun, 2014 06:29 pm
If your father is hospitalized in the United States, many of them have patient advocate services and social services available to help you find resources and be a voice for your father.

Ask the nursing staff to put you in contact with these services. They can be very helpful to you.
farmerman
 
  2  
Reply Sun 15 Jun, 2014 06:55 am
@Butrflynet,
the "patient advocate system" is a wonderful addition to an otherwise non-caring system

0 Replies
 
kvdpraveen
 
  1  
Reply Sun 15 Jun, 2014 11:52 pm
@Butrflynet,
Thank you for your advice Butrflynet. No he is not admitted in United States. He is in India.
0 Replies
 
 

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