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Diabetic. Had stroke. Hypertension. Feeling numbness and weakness in arm and legs. Suggestions?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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Answered by

Neurologist
Practicing since : 1994
Answered : 5383 Questions
Question
Dear Dr

My name is XXXXX I had a stroke some weeks ago. I was treated at Akademiska in Uppsala.

I have still pretty severe problems with my left side, thats why I whant to talk with a doctor during my time on vacation.

This is a short description of my condition made by Dr Jianman Lin/ Uppsala/ ;
Enrollment Cause Transient left-sided weakness.
Medical history 65-year-old man with preexisting hypertension and type 2 diabetes, treatment and followed up on the medical center during the year, however, poor medication compliance, not taking pills for a long time. Sick about an hour before the arrival of numbness and weakness in the left arm and leg as he sat in the car. Symptoms are almost fully restored in the emergency department at 16 o'clock. Assessed as TIA. Laid into the department for observation.

Since I am a new patient I did put the swedish journaltext which I have received electronically in the Google translating module which is added as attachement.
I realise that I havn´t cared much about my health but this now need to be changed.
i am more stief and feel more tightness-numbness in left side today than when i left hospital.

Chanses it get even worse or better?



Sincerely,
XXXXX
telephone +46-704-0000
....................................................

Appendix
2013-06-14 Consultant XXXXXXX Sjölin Physicians Neuro reception
Type of Consultant Neurologist Consultant
Contact Reason Rescue brain-alarm.
Medical history
Active health problems type 2 diabetes. Hypertension.
Current health concerns Today at 14:55 ill with numbness of the left arm and leg as he sat in the car.
Step out of the car and then noticed that he was also weak in the whole left side, could not stand up.
Got the help of a neighbor and to get to Emergency
Once at the ER, almost all observed symptoms
regress, remain numbness in the left leg below the knee. No speech or other neurological
symptoms. No headaches

…..........
2013-06-15 Day notes XXXXXXX Okembia Jonsson, Physicians Medical Department 30 E
Medical history
Current health problems Assessed as TIA / minor stroke. Continuing feeling as "soreness" in the left
leg, CT brain shows slightly dilated ventricles. High-risk profile with poor compliance. Not taking BTch
as prescribed-these are reinstated. High Glucose B-20 on arrival with Insulin vb. Pathological ECG
substantially completed electrical axis, characters to substantially kammarhypetrofi. Telemetry no
arrhythmias. Trop I x 2 neg. Sending referral for ECO shall be made on Monday before completing
infarction? Carotid Doppler-referral sent via AKM. Assessment Team on Monday. GDP will be
tomorrow. Follow sugar and BT. Initially nursed at 30 E is now transferred to the stroke unit.
….............

…..................
2013-06-17 care plan Ingela Galman, Physiotherapy stroke unit 65 B2
Medical history socially
Accommodation Lives with wife in the big house.
Status activity
Independent Movement of movements in / out of bed.
Walking Ambulatory without aid. Pt himself describes that time does not feel quite as usual with a
little light headedness is no big hassle.
Motor Ser sidlikt when pt picks matches. Pt describes the left hand requires more concentration.
Coordination When testing finger-nose + diadokokinesi: no major side difference, can be suspected
that it is slightly more difficult with the left hand. Pt describes the left hand requires more
concentration.
Muscle Function Rough Kraft upper example, sidlikt at test
Sensory impressions
perception
Extinguishing No.
Sensibility u.å.
Composite status Physiotherapist; Independent in transfers, ambulation without support. pt himself
describes it feel somewhat balance problem. No apparent difference in the side test of coordination
and fine motor skills, however, describe the item that he feels he needs to focus more to handle the
movements with the left hand. U.å. when testing the rough force (top example) and touch

..........................

Referral from Dr Einar Rystedt, stroke department, with issue carotid stenosis.
status
Duplex Vascular Neck: Right side: Light wall changes in the bulb and proximal ICA without
restriction of the lumen. Common carotid artery, carotid artery and external carotid artery and vertebral
subklavia without remark. Normal flow rates and normal flow profiles in all arteries. Left side: Normal
findings.
assessment
Assessment No carotisstenoser. Small wall changes ICA right.
other Information
Review statements E-referral answered.
Diagnosis & measure code Z018-Other specified special examinations-Main Diagnosis
AP073-Ultrasonography, neck receptacles (duplex technology) (!)-Solution
.............
.......
......
Neurology Principal Consultant Dr Jianman Lin.
Length of stay 2013-06-14 - 2013-06-18, Stroke Section 65 B2.

Diagnosis & measure code G459-transient cerebral ischemic attack, unspecified-Main Diagnosis
I109-Essential hypertension-Secondary diagnosis
E119-giving) complications-Secondary diagnosis
E785-Hyperlipidemia-Secondary diagnosis
E039-thyroidism-Secondary diagnosis
Z720B-snus-Secondary diagnosis
XS918-Physiotherapist-Action
XS910-Occupational Therapist-Action
AA011-CT scan, brain-Action
AF020-Doppler echocardiography, transthoracic, simple (!) Solution
AP073-Ultrasonography, neck receptacles (duplex technology) (!)-Solution
Enrollment Cause Transient left-sided weakness.
Medical history 65-year-old man with preexisting hypertension and type 2 diabetes, treatment and
followed up on the medical center during the year, however, poor medication compliance, not taking
pills for a long time. Sick about an hour before the arrival of numbness and weakness in the left arm
and leg as he sat in the car. Symptoms are almost fully restored in the emergency department at 16
o'clock. Assessed as TIA. Laid into the department for observation.
Health Progress Emergency CT brain shows no bleeding, mild vitsubstansförändringar periventrikulärt
as in chronic ischemia. Patients cared for initially in medicine department 30 E. Bad medicine
compliance. High blood pressure and high blood sugar on arrival. Can insulin injections if necessary at
mealtimes. Telemetrimonitoring more than one day without arrhythmias. Troponin I x 2 negative.
ECG signs of left ventricular hypertrophy and left aligned elaxel. Clinically no heart failure symptoms.
GDP normally. Further evaluation with cardiac echo. No påvosbar embolikälla. Systolic left ventricular
function in the lower normal range. Signs of diastolic dysfunction. Mild left ventricular hypertrophy.
No flap significant leaks. Undergoing also carotisduplex where no significant stenoses seen in the
carotid artery. Lipids with only slightly elevated LDL of 3.3. The whole thing is considered a TIA
anamnestic. They become familiar with the Trombyl with a loading dose, then 75 mg x 1 and
Simvastatin 20 mg x 1 customary secondary prophylaxis. Will information about the importance of
treatment for hypertension and hyperglycemia. Continued monitoring of Fålhagens medical center as
before. Referral sent there for information and follow-up. It is noted on CT brain on narrow
konvexitetslines, the ventricles are not particularly dilated. Team Assessed. There is no typical
symptoms / status of normal pressure hydrocephalus.
Current drugs for utskrivning_ T Metformin 500 mg, 2 x 3rd T Losartan / Hydrochlorthiazide 50
mg/12, 5 mg, 1 x 1. T Mindiab 5 mg, 1 x 1. Felodipine 10 mg, 1 x 1. Januvia 100 mg, 1 x 1.
Simvastatin 20 mg, 1 x 1. Trombyl 75 mg, 1 x 1. Emconcor 2.5 mg, 1 x 1. Levaxin 50 mcg, 1 x 1.
Action
Planning Should not drive for a month. Continued follow-up by family physician for blood pressure
and blood lipids. Nothing planned return of a stroke clinic.
Referral to a referral to the family physician, FÅLHAGENS HEALTH CENTER.
.........................

Date: 2013-06-17
Execution unit: X-Ray Clinic at the University Hospital
Opinion: doctor: XXXXXXX Ulf / Secretary: No DT Brain: NPH? Study without iv contrast. No previous
images cf. No intracranial hemorrhage, expansivity or definable infarction. Mild periventricular,
probably chronically-ischemic vitsubstansförändringar. Something far ventricles with relatively narrow
konvexitetslines over the vertex, single dilated furrows. Can comply with NPH, the clinical symptoms
of this exists. 2013-06-15 13:25 Sign.1 (Provisional Response): XXXXXXX Ulf 2013-06-17 08:22 Sign.2
(Final Answer): Lars Eliasson 1 of 1 statements have been received.
Signed: Eliasson Lars
Attested: 2013-06-18 Jianman Lin, Physicians
Posted Tue, 13 Aug 2013 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 1 hour later
Hi Mr XXXXXXX

Thank you for posting your query.
I can understand your concern after having had a minor brain stroke, and not knowing what to expect in future.
However, I would like to reassure you that once you continue the medications, and control your risk factors such as blood pressure, sugar and cholesterol, then, the risk of recurrence of strokes in future is very low.
I hope it helps.
Please get back if you require any additional information.

Best wishes,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, Hyderabad,
My personal URL on this website: http://bit.ly/Dr-Sudhir-kumar
My email: YYYY@YYYY
My blog: http://bestneurodoctor.blogspot.com/
Above answer was peer-reviewed by
 
Follow-up: Diabetic. Had stroke. Hypertension. Feeling numbness and weakness in arm and legs. Suggestions? 57 minutes later

My symptoms has increased since I left hospital one month is this normal ?

Should I pratice?

Eat herbal supplements?


 
 
Answered by Dr. Sudhir Kumar 3 minutes later
Thank you for getting back with more details.

Generally, the symptoms should get better after discharge from hospital, so, if your symptoms are worsening, then it is not usual, and needs to be evaluated by a neurologist.
You can do regular work and exercises.
Regarding herbal supplements, if they are safe and effective, you can take them.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by
 
Follow-up: Diabetic. Had stroke. Hypertension. Feeling numbness and weakness in arm and legs. Suggestions? 10 minutes later
Say that my symptoms increased ony 10 - 15 % could i then wait some weeks?
 
 
Answered by Dr. Sudhir Kumar 2 minutes later
Thank you for getting back.

If the symptoms have increased only 10-15%, and there are no new symptoms (from the time of admission), then you can wait.
However, please ensure that you are taking all the medications, and your risk factors are under good control.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Diabetic. Had stroke. Hypertension. Feeling numbness and weakness in arm and legs. Suggestions? 3 hours later
Thanks a lot.

I like to inform that my sugar is down to 5,9 but blodpressure is still high 169/95.

Kindly
XXXXXXX Smeds
 
 
Answered by Dr. Sudhir Kumar 5 hours later
Thank you for getting back.

You should bring down the blood pressure a bit more, 140/90 mmHg or lower is a good target BP for you,

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
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