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Had ischemic stroke. Use walker. Suffer complete tear of rotator cuff of shoulder. Suffer stiff hand and thumb. Cure?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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I had an ischemic stroke on 5/10/10. I still use a walker, but rarely need a wheelchair to get around. My cortex was barely affected with no aphasia or dimunition of memory or reasoning. But partly due to falls in a rehab center, I suffer from a completye tear of the rotator cuff of the rt shoulder. My other remaining major probnlem is a stiff rt hand and thumb. The Drs at Barrows Neurological suspect a variant of Parkinson's and have scheduled a DAT scan. Several PD drugs like baclofen have had NO effect. I have had a negative EMG test and 3 yrs of physical therapy with no effect on my hand and shoulder. Any ideas for a DX or TX?? I am 71,; had a CAT scan of the brain & shoulder---but can't have any MRIs because I have a defibrillator,.

I don't know how to use my scanner, but cAN fax THE SHOUILDER & BRAIN CAT SCANS IF YOU GIVE ME A FAX NUMBER. /GPK
Posted Sun, 29 Sep 2013 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 8 hours later
Brief Answer:
Could be due to old stroke or CBGD

Detailed Answer:
Hi,
Thank you for posting your query.

I have gone through the details provided by you. Based on that, there are two diagnostic possibilities:

1. Sequelae of old ischemic stroke- if your old stroke was in the left hemisphere of brain, it can lead to stiffness and weakness of right hand and thumb.

2. Cortico-basal ganglionic degeneration- in this condition, one hand becomes stiff, sometimes so stiff and rigid that it is almost dysfunctional, some pain may also be present. In addition, there is slowness. So, it is also considered as a variant of PD.

I have not examined you, but I feel botox injections may be useful, and this possibility needs to be explored further.

It would be useful to see the CT scan of your brain. Regarding FAX number, please contact the healthcare magic team.

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: Had ischemic stroke. Use walker. Suffer complete tear of rotator cuff of shoulder. Suffer stiff hand and thumb. Cure? 3 hours later
wouls sending you the brain CAT scan help you further. What TX will help me? Drugs? More PT or new OT? Surgery? Hyperbaric oxygen or ketamine? Why would botox help? No one has suggested that
 
 
Answered by Dr. Sudhir Kumar 51 minutes later
Brief Answer:
CT report may help

Detailed Answer:
Hi,

Thank you for getting back.

The CT report may help, to correlate your current symptoms, whether they are due to old stroke or not.

Treatment at this stage would be medical (with medicines) and OT/PT.

There is no role of surgery or hyperbaric oxygen or ketamine.

Botox reduces muscle stiffness, that is the reason it may work. You would need clinical examination to confirm the usefulness of Botox.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Had ischemic stroke. Use walker. Suffer complete tear of rotator cuff of shoulder. Suffer stiff hand and thumb. Cure? 9 hours later
My friend XXXXXXX claims he is faxing the 2 pp CAT scan now. Pls review it and correlate it with what I have told you and RESOPOND FURTHER

 
 
Answered by Dr. Sudhir Kumar 35 hours later
Brief Answer:
CT scan report not received yet.

Detailed Answer:
Thank you for getting back and for your immense patience.

I followed up your case with the administration of Healthcare magic and they informed me that there is no FAX machine available in their office. They have suggested you to take a picture with a camera and upload the report here as an attachment.

I would be pleased to comment on the CT report, once I receive it.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by
 
Follow-up: Had ischemic stroke. Use walker. Suffer complete tear of rotator cuff of shoulder. Suffer stiff hand and thumb. Cure? 1 hour later
THE STAFF AT HEALTHCARE MAGIC FINALLY PROVIDED A FAX NUMBER AND THE REPORT WAS FAXED. PLS CK WITH THEM AND THEN REVIEW IT AND GIVE ME YOUR FURTHER COMMENTS
 
 
Answered by Dr. Sudhir Kumar 20 hours later
Brief Answer:
CT scan of brain looks good

Detailed Answer:
Thank you for getting back.

I was able to view the pdf copy of CT report you sent on the email.
It is good to note that there are no brain infarcts, and the angiogram too did not show any significant narrowing. So, this rules out brain ischemic stroke as a possible cause for your symptoms.
Now, we need to explore the CBGD (Parkinsonian variant) for a possible cause for your symptoms. PET scan would be helpful in that.

Sorry for the delay (which was beyond your and my control), and than you for your patience.

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