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Is it advisable to undergo an operation for right leg movement that was dysfunctional post Right Frontotemporoparietal craniotomy ?

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Hello i am care taker of a patient Named XXXXXXX . Mr XXXXXXX had met with the accident and was admiited into hospital on 2.6.11 with severe head injurywith large inter hemispheric bleed He was operated for the rame ( Right Frontotempoorparietal craniiotomy and evaucation of sah done on 5 XXXXXXX 2011. His left leg was not working immeideiately after operation . However there is slight imporvement now ( say 5%) in left leg movement . On 20th XXXXXXX we have shown XXXXXXX to Neurologiest at Nagpur , who adivsed CT scan . The CT scan result are as follows 1) Previously visulaized large subfalcine subdural hematoma on right side appear mildly reduced in size 2) Previouly visulaized few small hemonhgic contusion in rightr frontal lobe are completely resovled on present scan with mild resedual edema 3) Large Post operative craniotomy defect noted in right fronto pariental 4) REst of the finding same as 6th XXXXXXX scan The CT scan of 6th XXXXXXX show the following Clinical Information: Pateint with infrcrnial haemorrahage due to head injury operted , post operative follow up Head CT FINDINGS : There is inter hemispheric haemorahage , mid and posterior portion of size ( AP) 55 , CC (46) RL 19 mm with displacement of right hemisphere laterally , the haemorrage is extending posterioriy downwrd towrd tentorial subdural region. There is genralized obliteration of CSF spaces on right side. There is craniotomy in right frotoparietal location with post operative changes. There is minmial air pocket in midline frontal inter hemispheirc post operative region. There is obliteration of right lateral ventricel . The paranasal sinus post traumatic changes are as per previous CT scan findings Interpretratoin . a) Mild to moderate residual inter hemispheric haemorrage , and mild extendion of the haemorrage towards tentorial region. b) Right Hemispheric edematous changes persistent c) Craniotomy in right front pareitral location with post operative changes, minimal air pocket in midline frontl inter hemispheric post operative region. Based on these interpretation the Neurologist in Nagpur adivsed Post paernelal parasagital Cranitomy evaculation of SPH . ( is this kind of operation) with some medicine namely Fruselac for 27 days . Mr XXXXXXX is also known case of rehumatic heart diseases . He has his MVR done in 2006. During our visits to Neurologist XXXXXXX also developed heart complication and admitted to heart hospital where heart doc told us not to take any medicine prescribed by neruologist for some days . On the other hand neoroligst says , if XXXXXXX want his leg back he has to do the operation which is mentioned above . WE are confused . When i am writing this letter to you , there is some improvement in leg movement . Earlier there was no movement , now the hip portion is moving but other part of left leg is defunct . WE are totally confused . WE nned your advise . It is very pertinent to mention the fact that we have exhsuted all our finances during the above treatment and now only option left is some mircale to happen . i would glad if your give me good advice based on my observation . I would also like to mention that i have become care taker of XXXXXXX just on humanatiran ground and his family has given all hopes .. lokking for favourable reply thank you very much for this patient reading . Please note i am basically a lay man so i just typed whtat report says , some mistakes might have crept in .
Posted Fri, 20 Apr 2012 in Stroke
Answered by Dr. A.S. Keerthi 13 hours later
Thanks for the query,

Personally I feel that you should not opt for a reoperation at this stage unless it is life threatening.

XXXXXXX is already on acitrom ( it tends to increase bleeding). Also he has developed a heart complication(details not mentioned).
For any operation Acitrom has to be stopped which is not advisable at this point of time.

It will take some time for the blood inside the cranium to get resolved(2-3 months) and for the improvement of power in his left leg.

For the timebeing continue the medications advised by the neurologist also and request your cardiologist to adjust the dose of Acitrom accordingly.

Keep doing regular physiotherapy.

I wish XXXXXXX God's speed and early recovery.

Above answer was peer-reviewed by
Follow-up: Is it advisable to undergo an operation for right leg movement that was dysfunctional post Right Frontotemporoparietal craniotomy ? 1 hour later
ok that is ok , but why nagpur neurologist was suggesting operation , can you please tell me why there is need of operation in lay man language , because i dont udnerstand the reports technicla langugae
Answered by Dr. A.S. Keerthi 21 hours later

Thanks for getting back to me.

The neurologist you consulted has planned to approach to the space between the brain halves through Post paernelal parasagital Cranitomy which is opening up the skull from above. This is to remove the blood clot present there.Which he may be thinking is the reason for the loss of control in the leg.This he would have arrived by seeing XXXXXXX physically.

According to me with the knowledge you provided, since the clot is mild to moderate which can resolve on own and the leg also regaining the its strength slowly. I would say for now continuing the medications advised by the neurologist and adjusting the dosage by cardiologist and avoiding the surgery as he has heart complication,is the safe and best option now.

Hope I answered your query.

Above answer was peer-reviewed by
Follow-up: Is it advisable to undergo an operation for right leg movement that was dysfunctional post Right Frontotemporoparietal craniotomy ? 4 days later
thank you for youre excellent guidenace , XXXXXXX has today moved fingers of the left leg . Are these good indication? Meanwhile i have one problem which i want to discuss with you . I have occasional head ache from the beginning. These head aches come because of stress , change in temepratrue , work over load etc. Sometimes i get heache when i take alchochal. These headaches go after i take crocin or nice tablet I have some BP problem , these are border lines BP . 85/135 , which come on occasions when i am in work . From Two years , i have different type of head aches , where in i feel some heavy XXXXXXX in the head . This type of heavy XXXXXXX dont go by eating crosine or any pain medicine , but dis appear automatically . Normally this type of heaviness last for 2-3 hours . and come when i am doing office work .. My questions is 1) is this heavnyess becasue of BP or some other reason 2) Why pain killers not effecting such type of heavniess 3) Is there any medicine for this .
Answered by Dr. A.S. Keerthi 28 hours later

Thanks again,

Any improvement in power is a good sign. I hope XXXXXXX will recover soon.

Coming to your problem, you seem to have a primary headache ( not related to high BP). You need to be examined before confirming that.

There are two type of medications for your headache - one to prevent such episodes and the other to get immediate relief. There are different classes of medications in both the groups and your neurologist will advise the right combination for you. Not all medications work for all people. Also it is better that you abstain from alcohol and plan your day so that you are not unduly stressed up.

Hope this answer is both adequate and helpful.

Above answer was peer-reviewed by
Follow-up: Is it advisable to undergo an operation for right leg movement that was dysfunctional post Right Frontotemporoparietal craniotomy ? 5 days later
talking about XXXXXXX , just from some days back he has migrine type of head ache , and is feeling uncomfortable in the head ,, he is feeling giddy, he went to neaurlogist , the neurollgist gave the following medicines 1) Filcita cd capsule 2) zevert tablet 3) etilaam . Is there any caue to worry ,, are the mediciens prescribed by the neurolgist in nagpur on corrrect lines ? Is head ache and feeling giddy is caue of worry? Regarding XXXXXXX leg , now its 65 percent recovered . He can now walk slowly . Please advise , The mediciens prescribed by neurologist XXXXXXX has started taking afater consulting cardiologist
Answered by Dr. A.S. Keerthi 23 hours later

It is good that XXXXXXX is recovering fast.

Nothing to worry about his headache and giddiness.

Follow your neurologist's advice and he will be alright soon.

He is getting the right medicine.

Dr. Keerthi.
Above answer was peer-reviewed by
Follow-up: Is it advisable to undergo an operation for right leg movement that was dysfunctional post Right Frontotemporoparietal craniotomy ? 23 hours later
but his head ache sometimes very severe and untolerable, does he has to manage this
Answered by Dr. A.S. Keerthi 8 hours later

Yes, some episodes would be intolerable but as he is on right treatment for this, I feel there should be no reason to worry.

As advised before to follow the neurologist's advise and he will be alright soon.

Wish him a speedy recovery.

Above answer was peer-reviewed by
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