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Having Symptoms Of Paralysis In Left Side Of The Body. What Should I Do?

Posted on Wed, 18 Dec 2013

Question: Hi My father went completely numb on Nov 20th around 21:00 ISt and we rushed to a Neurologist immediately. He administered an Injection which helped in regaining consciousness. I have attached the MIR and Angelography reports as well. Currently he has gained consciousness and is in ICU. However there are symptoms of paralysis in the left side of the body. However he can open his left eye, move left leg though without any strength/control. Please guide on how to proceed. Also I can provide current medication he is taking..

Answered by Dr. Sudhir Kumar (8 hours later)

Brief Answer: Thank you for posting your query. Detailed Answer: Hi Mr XXXXXXX I have gone through the MRI reports of your father and seen the medications list too. He has suffered a brain stroke, affecting the right side of brain, as a result, he has paralysis of the left side of body. The only treatment for improving stroke quickly is thrombolysis with a medication called as tissue plasminogen activator (actilyse), which can be given within first four and a half hours after stroke onset. I do not think your father received this injection. As of now, the treatment would be mainly physiotherapy and exercises, and recovery would take a long time (several months). In addition, his blood pressure should be controlled. Medications would include aspirin or clopidogrel (blood thinners) and a statin such as rosuvastatin to prevent any stroke in the future. I hope it helps. Please get back if you require any additional information. Wishing you good health, Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist Apollo Hospitals, Hyderabad, India Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar My BLOG: http://bestneurodoctor.blogspot.in

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (1 hour later)

Dear Sir, Thank you for your answer. Apologies that I missed out to include the injection details. My father received the injection within 90 minutes of the stroke (attached a screenshot of the injection, I guess its the same one you are referring to. Also doctor told us that this injection has side-effects in 5-10 % cases, but re-assured us next day that injection was a success. However, the MRI report is telling a different story as it lead you to think too that injection wasn't given. I will add more details to the events that occured: Time of Stroke: Around 21:30 IST on Nov 20. MRI Done Around 10:30 am on Nov 21. Blood Pressure is normal from yesterday along with Na+ and K+ levels. My father can also move his left leg on command however is sub-conscious most of the times due to medications. Please suggest as if any further treatment is need or physio-therapy is the only solution? Thanks & Regards, XXXXX

Answered by Dr. Sudhir Kumar (2 hours later)

Brief Answer: Thank you for getting back. Detailed Answer: Based on the prescriptions attached, I could not find a mention of the thrombolysis with tissue plasminogen activator (actilyse). You can confirm this with your neurologist. The cost of the injection is about 50-60 thousand rupees. Yes, at present, physiotherapy is the only solution for improving his weakness and paralysis. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (44 minutes later)

Thanks for the response. I added another attachment in the morning but I guess that it is not reflecting at your side. I am quoting what is written on the injection cover which was administered: "Recombinant Tissue Plasminogen Activator" (TNK-t-PA Injection 40 mg) Velix-40 Tenecteplase Injection 40 mg The injection quote was 36000 INR and was administered with a timer of 30 minutes. Quoting again to avoid confusion: The injection was administered within 90 minutes of the stroke and MIR report is from 13-14 hours after the stroke. As per your advice we would definitely provide dedicated therapy sessions along with prescribed medicine as well as diet. I just wanted a reassurance from an expert like you to confirm that we are on right course and how exactly injection helped as paralysis is still visible? Thanks & Regards, XXXXX

Answered by Dr. Sudhir Kumar (2 hours later)

Brief Answer: Your father has received the correct injection Detailed Answer: Thank you for clarifying and providing more details. Yes, that is the correct injection and your father has received the best treatment in the initial period. I agree with you that the MRI report does not show significant improvement after the injection, but that does happen in about 30% of patients. However, they improve over time, and at the end of 90 days (three months), they have better outcomes (less disability) than those who did not receive the tissue plasminogen activator injection. So, you should continue the physiotherapy and the medications. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (22 hours later)

Thanks for the reassurances. However there are few ongoing observations on which I would require your second opinion: 1) My father is experiencing persistent headaches which increases to intolerable levels sporadically. 2) Today my father is also experiencing pain in the left side similar to that of the gunshots, so is it supposed to be normal? 3) They stopped medication for BP to observe body's response but unfortunately it shot to 190 and forced medical team to resume medication. Reiterating for transparency it is Day 4, so is it normal or should we be worried? Thanks & Regards, XXXXX

Answered by Dr. Sudhir Kumar (2 hours later)

Brief Answer: Thank you for getting back Detailed Answer: It is common for patients with stroke to get headaches. The most common reason is vascular headache, similar to migraines, where medications such as flunarizine and pain killers would suffice. However, three other possibilities should be excluded: 1. Worsening of brain infarct (increase in the size of infarct), 2. Cerebral edema or brain swelling, 3. Any bleeding into the brain infarct. All these three possibilities can be excluded by doing a CT scan. If your father's headache does not subside, I would advise for doing a CT scan of the brain. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (1 hour later)

Thanks for your quick response. First of all apologies for asking so many questions, and I might sound annoyingly skeptical sometimes but I guess it is natural in my situation and I hope you will understand. I discussed it with the nerologist in charge and he explained with certain examples the cause of these headaches. According to him, the affected part called infarct I guess is equivalent to dead cells in that region. This affected region is bound to swell and is the reason for headaches as this swollen area puts pressure on the active region. In his opinion the swelling or headache disappears in 5-7 days and then it doesn't return. He also assured that medications to subdue swelling is being administered and will help slowly. I wanted to reconfirm as the terms "cerebral edema" and "vascular headache" sound different but I can't judge for sure what is applicable here. Should I wait for another day or two for headache/swelling to subside, or push the doctor to arrange for CT Scan? Thanks & Regards, XXXXX

Answered by Dr. Sudhir Kumar (3 hours later)

Brief Answer: Thank you for getting back. Detailed Answer: I welcome all your questions and please be reassured, they are not annoying. I would be pleased if my answers help you and your father even little bit. The doctor's explanation is similar to what I mentioned in point 2 above (cerebral edema or brain swelling) and I agree with your doctor here that the swelling is maximum of day 4, and tends to reduce after that. If your father's neurological condition (other than headache) is stable, there is no urgent need to do a CT scan of brain now. On the other hand, if he becomes more drowsy than before, or if his weakness of arm or leg worsens, or if he develops fits, or if the pupil size becomes unequal (can be found out by torch-light examination of eyes), then, an urgent CT scan of brain should be done. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (42 hours later)

Thank you for your response and I am glad that your words reflect full co-operation. As per your advice, my father went CT Scan yesterday evening and we have got the report back. The physician here is ready to discharge my father from Hospital today but I would need your advice too. I have attached the CT scan report and you can check it in the attachments. In case you can't find the attachment, then please refer to below excerpt from the report for quick reference: "Large wedge shaped hypodense areas are seen in the right fronto temporo in the parietal region. This is seen to affect grey and white matter with effacement of the adjacent sulei. The right basal ganglia is also affected. Partial effacement of the right lateral ventricle is also seen. Few infarcts are seen in the bilateral external capsules and basal ganglia. Subtle periventricular ischemic white changes are noted. ... IMpression: F S O fresh right sided MCA territory infarcts. Old lacunal infarcts in both the cerebral hemispheres. Subtle periventricular ischemic white matter changes. Cortical-cerebral and cerebellar atrophy Please respond ASAP as time is of essence now.. Thanks & Regards, XXXXX

Answered by Dr. Sudhir Kumar (31 minutes later)

Brief Answer: Your father can be discharged. Detailed Answer: Thank you for getting back. I have gone through the CT scan reports and it does not show anything of concern. So, I agree with your doctor's advice and your father can be discharged from the hospital. Treatment can be continued as discussed earlier. I would be pleased to answer any follow up queries. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (2 days later)

Thanks a lot..My father was discharged from the hospital yesterday and looks better. However there are few observations which alleviates my worries.. 1) If me father meets somebody he recognizes them immediately.. but after few minutes he doesn't and then again he recognizes.. sometimes he doesn't recognize at first while he does later on..and it goes like this 2) His emotional behaviour is also strange as he holds no grudges against anyone..Rather he insists on meeting people that I might term as "mortal enemies" 3) He experiences pain in the affected left side now and then I am wondering if these symptoms will disappear with time or they are permanant or there is any medication for them? It is worth taking my father to a specialist in Delhi if medicine is of help..as long journey can be difficult for him Awaiting your responses.. Thanks & Regards, XXXXX

Answered by Dr. Sudhir Kumar (4 hours later)

Brief Answer: Thank you for getting back. Detailed Answer: I have gone through the symptoms of your father as you have described. These would improve over time. Regarding the pain on the affected side, pregabalin capsules may be useful. There is no need to take him to Delhi at present. Regarding your first sentence, did you mean "alleviate"? Alleviate means less, I think what you meant was more worries, but in any case, there is no need to worry. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (5 minutes later)

Thanks for the quick response..and yes I meant "doesn't alleviate"..will keep you posted..

Answered by Dr. Sudhir Kumar (2 minutes later)

Brief Answer: Sure... Detailed Answer: I would be pleased to be of help in the future too. Best wishes, Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar