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74 years old. Facing irregular blood pressure and low heart beat. Brain mri done. What treatment is required?

Nov 2013
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My mother is 74 years old and has been facing irregular blood pressure and low heart beat. The blood pressure used to be high (140-90 or 140-100) and she was under medication using Telma 20. Later she started having very low blood pressure and low heart beat ( around 60) and she stopped medicine. After one week this caused her blood pressure to rise to very high level of 190-120. On restoring medication, bllod pressure returned to normal. She had also had three episodes of fainting for few minutes in last one year.
Her ECG and Echo Cardiogram were normal. Also in last six months two times 24 hours Holter study was done which was normal. Bllod test normal except for very high ESR at 49 and high Vitamin B12 of 1804.

A Brain MRI was also ordered. Brain MRI has revealed as under.

1. Brain MRI finding suggesting of few supra tentorial areas of chronic ischemic foci with diffused cerebral atrophy.
2. Brain MRI study reveals few discrete areas of T2/ fast flair hyper intense foci seen in balateral cereventricular and right basal ganglia suggestive of few chronic ischemic foci.
3. Rest of cerebral hemisphere shows diffused age related atrophy as evident by prominent cortical sulci, bilateral sylvian fissure and other sub-arachnoid spaces.
4. Supra tentorial system is prominent.
5. Brain stem, pitutory gland is normal.
6. Conclusion: Pl. Correlate Clinically.

Request advise on diagnosis and suggested line of treatment.

Posted Sat, 24 Nov 2012 in Hypertension and Heart Disease
Answered by Dr. Sudhir Kumar 5 hours later
Thank you for posting your query.

There are two diagnostic possibilities for her fainting episodes:

1. Syncope- in this condition, the brain does not receive blood for a while and the person faints. After falling down, brain gets the blood flow restored and the person becomes conscious within one minute. This may happen because of low BP, extreme tiredness, fatigue, loose stools, etc.

2. Ischemic seizures- as per her MRI report, there are ischemic areas (small areas of blood clots). This can give rise to seizures resulting in fainting.

Regarding treatment, she needs evaluation by a neurologist. EEG test may be required if not done.

Medications such as aspirin is useful in treating brain ischemia.

If the doctor feels that she has ischemic seizures, she would require anti-seizure drugs such as levetiracetam.

I hope it helps. Please get back if you have any more queries.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad
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