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Diagnosed stroke and bleeding in brain. Prescribed anti-coagulants. MRI result show acute infarcts with mild hemorrhagic transformation. Cure?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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Practicing since : 1994
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Dear Sir,
Greetings. I'm XXXXXXX from Kadapa and currently doing my PhD in South Korea. Patient is my brother G XXXXXXX Last tuesday, on his business trip, he went to hyderabad driving alone all the day and next morning he was not able to speak properly, dizziness and the mouth moves a bit aside. With the hotel boy help, he joined in nearby Himagiri Hospital. After diagnosis, they told he was affected by stroke and there was a bleeding in brain. Dr. XXXXXXX (from Apollo clinic) was the corresponding doctor who gave treatment and prescribed drugs for anti-coagulants and drugs for making blood thin. During treatment in hospital, medications given was IV fluids, Tab. Atorva 40mg, Inj. strocit 500mg/100ml NS, Inj. PAN 40mg/iv and physiotheraphy. Also MRI, echo cardiograph, haemotology, PT with INR, urine, RFT, LFT tests were conducted. MRI result was - acute infarcts with mild hemorrhagic transformation in right middle cerebral artery territory. During the discharge on saturday doctor prescribed drugs to follow that I mentioned in Current medications section. Also doctor asked to have blood tests in between and let her know about the status.

Sir, asking for your suggestion/second opinion, I'm afraid how serious was my brother condition. I'm little bit confused with the drugs given was for the clots where actually my brother was told its bleeding. As we are less aware of condition and also worried about my brother health, as you can understand our anxiety, should we continue the prescribed medications till the completion of course and check for the improvement condition or should we take any other systematic diagnosis & treatment. As far now my brother looks sound daily video chatting, looking fine talking good, moving actively except a slight slide with mouth muscle, however he is going for physiotherapist for that. I feel OK but still a little tension about the severity and about the probability of this problem occurrence in future. Please give your opinion sir. I uploaded the reports to your yahoo account as there is no option here to upload files to you. please go through sir.
Posted Sat, 20 Jul 2013 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 50 minutes later
Hi,
Thank you for posting your query.

I have read your notes regarding your brother and gone through all the reports.
What he had was a brain stroke (ischemic type), where the blood supply is reduced to a part of brain, in his case, it was the right side of brain.
He is a young person and we need to be sure about the causes of stroke. Complete evaluation may require trans-esophageal echocardiogram and thrombophilia profile, in addition to the tests already carried out. However, I would like to see him before ordering any more tests.

As of now, the medications are correct. The bleeding is the transformation of the infarct, and not a primary bleed. I agree with you that if a person had primary bleeding in the brain, then, we do not use blood thinners.

Please continue the same medications and physiotherapy. If possible, I could see him at Hyderabad.

I hope it helps. Please get back if you have any more queries.
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/
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Follow-up: Diagnosed stroke and bleeding in brain. Prescribed anti-coagulants. MRI result show acute infarcts with mild hemorrhagic transformation. Cure? 2 hours later
Dear Sir,

Thank you very much for the reply. Sir, I would like to show you the other reports of my brother which were taken in XXXXXXX Hyrudayala, Bangalore 2 weeks before the current stroke happened. At the end of May, in my hometown, he suffered sudden dizziness, heavy sweet, back muscles contracted and rushed to hospital there they said seems mild attack. But the thing is he was not collapsed. Then went to Bangalore and joined in XXXXXXX Hyrudayala. There they conducted echocardiogram, coronary angiogram, coagulation report and normal blood & urine tests. I uploaded the reports please have a look sir.

Finally it was told that its not exactly heart attack but a minute blood clot on artery wall and prescribed medications. The big mistake from our side is my brother neglected the medications as he was very active at that time saying it was just a minor problem goes well with time. But unfortunately recently this stroke occurred.

Sir this is the complete status of my brother. Now I suppose you understand the complete problem. Please go through the reports and comment the severity of the condition whether the problem is only with the clotting of blood and not with brain or heart in particular.

Thanks & Regards,
 
 
Answered by Dr. Sudhir Kumar 1 hour later
Thank you for getting back with more details.

I have gone through the details of heart reports. As per that, he had a clot (thrombus) in the heart artery too, and the pumping of the heart was also poor. Now, the clot is there in the brain artery. So, he has suffered a heart problem earlier, and now the brain problem. The underlying reasons for both are same. Fortunately, the treatment and medications for both are also similar.

So, he should continue the medications on a regular basis to prevent further heart and brain problems.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Diagnosed stroke and bleeding in brain. Prescribed anti-coagulants. MRI result show acute infarcts with mild hemorrhagic transformation. Cure? 3 hours later
Thank you very much for the clarification doctor.

Sir, it would be grateful if you suggest us regarding the diet. Foods which will be useful to improve the condition and the foods should not be taken like about spices, non-veg etc.
 
 
Answered by Dr. Sudhir Kumar 16 minutes later
Thank you for getting back.

High fat/cholesterol foods such as red meat and chicken with skin should be avoided. However, fish and skinless chicken can be had once or twice a week.

Salads and veg food are alright.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Diagnosed stroke and bleeding in brain. Prescribed anti-coagulants. MRI result show acute infarcts with mild hemorrhagic transformation. Cure? 2 days later
Dear Sir,

Good afternoon.

I came up again with another query. Upon our correspondence doctor's, Dr. XXXXXXX prescription my bro taking T.Warf and T.clodrel from 27/6/13 and doctor asked to examine blood test regarding PT test. During these 3 days my bro experienced no bleeding from his body (doctor told there could be a possibility of bleeding).

Today we done blood test and here I attached the report. Please go through and suggest us if we can go normally through the prescribed medications.

Thanks & Regards,
 
 
Answered by Dr. Sudhir Kumar 2 hours later
Thank you for getting back.

Bleeding is a complication of warf and clodrel, as they make the blood thin. However, it happens only in a minority of patients. If bleeding happens, you should ask your brother to stop warf and clodrel, and report to the doctor.
I could not find the PT/INR attachment. May be, you can type the values here, if you can not attach the report here.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Diagnosed stroke and bleeding in brain. Prescribed anti-coagulants. MRI result show acute infarcts with mild hemorrhagic transformation. Cure? 16 hours later
Dear Sir,

Sorry for the delay here i attached the file please find. However here I'm mentioning the PT report figures - Patient Plasma/Automated coagulator meter - 17.0(observed) sec ; control value 12 sec ; INR 1.47


Doctor I have a small question regarding food. While I'm browsing, patients experience with similar problems, stated boiled egg could be best alternative to non-veg food; daily one would be useful. mostly which part of egg, yellow or white part would be advantageous, as my bro doesn't like yellow part that's why I'm asking. Also doctor regarding milk which type would be better like skimmed/toned etc.

Sir finally I wish to know how should we can make our blood thicker to thinner/normal to avoid further frequent clots and subsequent problems. Apart from the drugs, Please tell me by listing the food, daily routine or any other regarding this issue

Thanks for your time doctor.
 
 
Answered by Dr. Sudhir Kumar 1 hour later
Thank you for getting back.
I have noted the PT/INR values. The dose of warf may have to be increased, as we want the INR closer to 2. Please discuss with the doctor.
Egg white is fine.
Normal milk can be consumed.
There is no other method than the medications to make the blood thinner. We should not aim to make the blood thicker.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
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