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Diagnosed with Uncompensated Vestibular Dysfunction. MRi scan showed mild degree atrophic changes with ventricular prominence. Suggest?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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Dear Sir,

If you can remember me please---
My Borther(34)- has been diagnosed with Uncompensated Vestibular Dysfunction, ENG Report- Bilateral Canal Paresis MRI Brain-Mild degree atrophic changes with ventricular prominence, Left PCA hypoplastoc, Plaque at CCA bifurcation. These diagnosis has been done with doctors in CMC vellore last week and was under treatment of Dr. Achamma Balraj ENT Dept.

Blood Test:- ESR 60'-07 MM, Creatinine- 1.04 MG%, Uric Acid-7.2 mg%, glucose random-163, glucose pp-111, cholesterol total-143, triglyceride serum-250, cholestoral hdl-33, cholestoral ldl-76, glycosylated hb-5.8, vit b12- 232.4, folic acid-7.00, vit d(25 oh)-27.75, crp-7.23

Kindly confirm what is the remedy and how much is this affecting his health concerns. What is the remedy for Brain atrophy and other allied symptoms?
ENT Dept told us that Vestibular Decompensation is still under research category and there is no medicine to control this now, but they told that sometimes Brain will compensate.

We are having sleepless nights throughout and need your advise...

Attached are last report during Apr-13. Current reports are not yet scanned as patient is still in Vellore.

Reards
XXXXX
Posted Tue, 15 Oct 2013 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 30 minutes later
Brief Answer:
Medical treatment and exercises are required

Detailed Answer:
Hi,
Thank you for getting back. I do remember your brother's case.

First of all, I would like to reassure you that current reports are not something to worry about and he would improve with medications and physiotherapy/exercises.

Mild atrophy on brain MRI is a subjective finding and no treatment is needed for the same.

Plaque at CCA bifurcation means mild blockage of blood flow in carotid artery leading to the brain.

This could be related to high cholesterol found in the blood.

As of now, I would suggest he uses aspirin (a blood thinner) and statin (to keep cholesterol in control). In addition, a low fat diet would also help.

In addition, vestibular adaptation exercises as taught by ENT/physiotherapy would also help.

Please keep me informed about his progress.
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 blog: http://bestneurodoctor.blogspot.com/


Above answer was peer-reviewed by
 
Follow-up: Diagnosed with Uncompensated Vestibular Dysfunction. MRi scan showed mild degree atrophic changes with ventricular prominence. Suggest? 27 minutes later
Dear Sir,

Thank you for your reply.

Can left PCA HYPOPLASTIC LEAD TO A CEREBRAL STOKE? What is the chances?

CRP level is also pretty high and any suggestions on this please..

After how much time would require to do again MRI,

His both ears are affected. Is this leading to hearing loss? In that case what exercises (Tai chi-Martial Art OR swimming exercises) would help him to regain health.

His current dosage to control cholesterol is Finate 160 mg 1 month once daily. What do you suggest?

Any surgery required in this or Later stage.. Please suggest that also.

Thank you..

Regards
XXXXX
 
 
Answered by Dr. Sudhir Kumar 51 minutes later
Brief Answer:
The stroke risk is negligible

Detailed Answer:
Thank you for getting back.

1. Hypoplastic PCA is probably long standing and there is very little risk of getting stroke due to that.

2. For high CRP and cholesterol, add rosuvastatin, in addition to Finate.

3. There is no need to repeat the MRI brain.

4. Regarding exercises, follow the advice of ENT doctor.

5. No surgery is required.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with Uncompensated Vestibular Dysfunction. MRi scan showed mild degree atrophic changes with ventricular prominence. Suggest? 46 hours later
Dear Sir,

My Brother also consulted Orthopedics surgeon. They have done 1 Chest MRI and the disease name is COSTOCHONDRITIS. mEDICINE xyloric MG twice daily for 1 month and Voveron SR for 2 weeks.

He told us to consult Neurologist for Brain. But as of now no appointments are available in CMC before next 1 month and he is there for nearly 2 weeks.

What do you suggest and how critical is this? In case CMC can't be contacted as Ari G Chacko need not be contacted hence it becomes imperative for us to get 1 appointment for Neurologist. If you would have been there then our problem would have solved. How is XXXXXXX XXXXXXX Hospital in case of any further appointment to be sought? Any preference from you please..

Also let us know whom can we contact(Neurologist) in Kolkata locally. Your preference and any local (Kolkata) Neurologists contact details please..

Also please suggest what is the exact name & dosage of resuvastatin (medicine you have suggested earlier) and how long will it continue.

ENT has suggested neurobian forte? What do you suggest and how will this medicine help him to regain health or support.

Thanking You

With Warm Regards
XXXXX
 
 
Answered by Dr. Sudhir Kumar 8 minutes later
Brief Answer:
Detailed replies are below

Detailed Answer:
Thank you for getting back.

The replies are below:

1. Costochondritis is a minor issue and there is a mild inflammation in the ribs on the sides of chest. They would go away with voveran.

2. Xyloric (allopurinol) is a medicine used for high uric acid in blood.

3. Neurologist consultation is not urgent (in that case, they would have sent him to the emergency dept and called the neurologist there).

4. XXXXXXX hospital is an average hospital.

5. At Kolkata, you can contact Dr XXXXXXX XXXXXXX (Apollo) or Dr XXXXXXX Choudhury (Peerless), both neurologists of good repute, and personally known to me.

6. Rosuvastatin (Rosuvas) usual dose is 10 mg and can be taken for three months once daily at night.

7. Neurobion forte is an age old vitamin B12 and can be used in any nerve problem.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with Uncompensated Vestibular Dysfunction. MRi scan showed mild degree atrophic changes with ventricular prominence. Suggest? 3 days later
Dear Sir,

Thank you very much for the advise and sharing local contacts in Kolkata. We shall get in touch with either of doctors you have mentioned in your mail with your reference.

Additionally please be noted following findings

a) Dr T Muthu(MD, DM Consultant Neurologists) in XXXXXXX Hospital was contacted as Orthopedics told us to get a consultation of Neurologist and no neurologists were available for appointment in CMC.

b) Spine MRI-Bulge in C6 C7. Neurologist told us that bulge is there but as it has not compressed any nerve not to worry now.

c)He has done BERA test yesterday but reports awaited, and told Brain MRI has revealed Atrophy but at initial stage. He has advised following medications

Tab Fourts B one tab daily.
Tab Stalopam Plus half tab daily at night.

and asked my brother to visit after 3 months. Every 3 months visit to CMC is getting tedious for us and we need to consult local neurologist for further action.


Basis on the records as cited above request your suggestion on findings and whether the medications are correct or not.

It would be nice of you if you share good ENT surgeons/doctors for further contact in Kolkata. Also request your opinion for NIMHANS, Bangalore preferring over CMC for next level visit.

In anticipation of your expert reply and thank you for your support.

Regards
XXXXX

 
 
Answered by Dr. Sudhir Kumar 47 minutes later
Brief Answer:
My replies are below.

Detailed Answer:
Hi,

Thank you for getting back with more information.

MRI spine and MRI brain do not show any significant abnormalities. So, there is no need to worry about them. For disc bulge, neck extension exercises could be done.

Regarding medications, stalopam plus contains escitalopram (a medicine for depression) and clonazepam (medicine for sleep and anxiety). I do not think your brother needs them at present, unless he has depression, anxiety and sleep problems. Fourts B is a vitamin and can be used.

Regarding ENT in Kolkata, I do not know anyone personally, but the neurologists I mentioned could help you in that.

NIMHANS, Bangalore is a good institute like CMC Vellore, but the XXXXXXX doctors are busy and the juniors run the show. If you are able to XXXXXXX a XXXXXXX then it is worth a second opinion, otherwise, it would not be of much use.

Best wishes,
Dr Sudhir Kumar Md DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with Uncompensated Vestibular Dysfunction. MRi scan showed mild degree atrophic changes with ventricular prominence. Suggest? 2 days later
Dear Sir,

Thank you for your valuable advise. Yes he has some depression/anxiety problems coupled with. He has also re-consulted Psychiatrist in CMC and doctors advised to continue the medications as before what they advised him 6 months back.

He returned back yesterday from CMC and I got summary of medical reports as attached herewith against AUV and Orthopedics diagnosis for your ready reference.

What apparently seems that he is in depression. I asked him to get introduced with Yoga classes regularly.

AUV doctors under guidance of A Balraj told that there is no medicine or control mechanism for this AUV uncompensated vestibular dysfunction.

This has created high impact to him.

Do you think that any Neurologists appointment as per your local contacts in Kolkata is required at this stage. Or he should continue with the medicines as advised by CMC and then consult after 6 months?

Is there anything to worry now? Your advise solicited keeping reference to the attached new re-visit reports. XXXXXXX Medicines or Summary reports not attached as still this is due.

Thank you.

Regards
XXXXX
 
 
Answered by Dr. Sudhir Kumar 1 hour later
Brief Answer:
Treatment is correct at present

Detailed Answer:
Thank you for sending the reports- AUV and ortho. I have gone through them, and there is no need to worry about them.
His current medications may be continued at present.
There is no need of any immediate neurology consultation at Kolkata.
Yoga sessions would be useful.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Diagnosed with Uncompensated Vestibular Dysfunction. MRi scan showed mild degree atrophic changes with ventricular prominence. Suggest? 2 days later
Dear Sir,

Thank you for your advice.. If you know any good Yoga Center in Kolkata which are specialized in this kind of malfunction treatment then it would be helpful to us. Also let us know any food habit very useful for brain and spine and can be useful as well.

Also need to know on Bilateral Canal Parasys which is in the ENG Report and how it can be rectified going forward.

Thanks for your support and look forward to seek your opinion in next course of action.

Regards
XXXXX
 
 
Answered by Dr. Sudhir Kumar 1 hour later
Brief Answer:
My replies are below

Detailed Answer:
Thank you for getting back.

I do not personally know any yoga center, however, if you have any local contacts, they could help you in locating one center.

Regarding food, he should eat on time, and avoid fasting. Non-veg at least twice a week, a lot of dry fruits, milk, etc are useful for brain nutrition.

Bilateral canal paresis treatment should be discussed with ENT doctor, as it pertains to an ear problem.

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