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Suggest Treatment For Severe Vomiting And Headache In An Elderly Person

Posted on Mon, 20 Mar 2017

Question: Hi, My grandmother 85 yrs suffered from severe vomiting one episode with headache post which she developed lt side hemiplegia 10 days back & on CT the same day detected to have hematoma in the rt thalamus. She was immediately hospitalized, post which she has been started on IV mannitol tds & IV augmentin , antacid & brain stimulator tab..The second day on admission she has severe vomiting again, one episode, post which was shifted to ICU with the same treatment for observation and RT inserted .After 5 days she was in wards and still hospitalized. She has on & off has irrelevant talk & behavior , unable to receognise place & person .Vitals have been stable throughout .Yesterday a repeat CT has been done which shows 1 cm increase in the hematoma

Answered by Dr. Ajay Panwar (8 hours later)

Brief Answer:
suspected metabolic abnormalities

Detailed Answer:
Hi,
Thanks for being on HealthcareMagic.
I am Dr.Ajay Panwar, Neurologist, here to answer your query.

Thalamic hemorrhage usually occurs in hypertensive patients. Thalamic hematoma can itself causes altered sensorium or abnormal talking intermittently.However,stroke patients are prone to develop metabolic abnormalities like abnormal serum electrolytes, kidney function tests, liver function tests.These abnormalities can predispose to fluctuation in sensorium or abnormalities in speech.
Also, dehydration can cause altered sensorium too. So, these things should be taken care of.

She should improve with time though.

Hope that helps. If you have further questions, I shall be glad to have you in follow-up.

Regards,
Dr.Ajay Panwar,
MD,DM(Neurology)

Above answer was peer-reviewed by : Dr. Arnab Banerjee

Follow up: Dr. Ajay Panwar (16 hours later)

Hi, thanks for your revert.

Would just need to understand the CT changes which show an increase of 1 cm in size of the hematoma done on the 10th day.
Has the same worsened ?
and when would a repeat CT be advisable.

Answered by Dr. Ajay Panwar (1 hour later)

Brief Answer:
There is a minor difference in two reports.Size may increase sometimes.

Detailed Answer:
Hi,
Thanks for being in follow-up.

In hemorrhagic stroke,, size of hematoma may increase in a few patients after stroke.The mechanism is not precisely defined, though rebleeding may be the cause. However, in your case, there is a minor difference in size. Clinical progress should be monitored here and CT should be repeated in case of any neurologic deterioration.

Hope that helps.

If you have any further questions,I shall be glad to have you in follow-up.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

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