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What could be the cause for memory loss with a history of cerebral stroke?

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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Neurologist
Practicing since : 1994
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Dear Dr., my father is an epileptic patient for 14 years. He was in medication since then. His recent medication is Tegrital CR 400 1 x 2, Lobazam 5 1 x 3, Levipil 500 1 x 2. He was ok till 2011. Then he had a cerebral stroke. The MRI report reads the following : "Findings are suggestive of an acute infarction in left corona radiata and adjoining paraventricular white matter. Multiple foci of ischaemic gliosis are seen in white matter of both cerebral hemispheres with few foci of ischaemic change or lacunar infarction in both basal gangila" Then the doctor added two more medicines : Deplatt 75 1 and Lofar 50 1. For last few months, he suffers from memory loss, becomes less patience, sometime unable to recognize his own house, loose control in urination, his health deteriorates etc. The doctor is not sure about the cause of these problem. I need your suggestion what to do ?
Posted Sat, 15 Feb 2014 in Brain and Spine
 
 
Answered by Dr. Sudhir Kumar 31 minutes later
Brief Answer: My reply is below. Detailed Answer: Hi, Thank you for posting your query. Based on the symptoms, your father could be suffering from dementia. It is a condition, where the brain function starts to deteriorate and the condition gets worse over time. The main symptoms could be forgetfulness (memory loss), behavioural changes, impaired judgment, impaired calculation, forgetting names of familiar people, getting lost on the way, lack of self care, lack of control over urination, etc. The diagnosis can be confirmed by doing a detailed neuro-psychological testing. The underlying cause could be lack of blood flow to the brain (as shown on the mRI report). There are good medications such as rivastigmine, donepezil, memantine, etc, which can make him get better. I hope my answer helps. Please get back if you have any follow up queries or 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
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Follow-up: What could be the cause for memory loss with a history of cerebral stroke? 11 hours later
Dear sir, Many thanks for your reply. I have three queries regarding your suggestions : 1. Can you please name a test/few tests which can be used to confirm dementia ? 2. The medications you mentioned, what would be the typical dose to start with for my father ? 3. If it is dementia, who should be concerned - a neurologist or a psychiatrist ? 4. Since we don't really know how to handle this problem, is he safe to keep at home or there may have some other options where he may get proper treatment ? Thanks, XXXX
 
 
Answered by Dr. Sudhir Kumar 29 minutes later
Brief Answer: Thank you for getting back. Detailed Answer: My replies are below: 1. Dementia can be confirmed by clinical examination and if needed, PET scan of brain. 2. The dose of these medications can be decided after seeing the patient. 3. A neurologist or psychiatrist, both are capable of treating dementia, and they would help you choose correct medicine at correct dose. 4. Usually, home treatment is preferred. I hope it helps. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: What could be the cause for memory loss with a history of cerebral stroke? 39 minutes later
Thanks doctor. Two more things to clarify - 1. I read in internet that medication side effect may be one cause of dementia. In my first query, I provide his current medications for the treatment of epilepsy and stroke. Is it possible that his current medication and dose may trigger dementia ? Just for the information, the medicines and doses are prescribed by Dr. Trishit XXXXXXX at AMRI apollo hospital, Kolkata. 2. My father lives at a remote place, a long distance from kolkata. No neurologists/psychiatrists are available in our locality on emergency basis. His current physical situation also do not allow him to travel. It will take a while to arrange an appointment with a doctor. Can I start medications as you prescribed till an appointment with a doctor ? His mental and physical condition is significantly deteriorates over a couple of months. Do these medications have any cross interactions with his current medications for epilepsy and stroke ? Thanks
 
 
Answered by Dr. Sudhir Kumar 8 minutes later
Brief Answer: My reply is below. Detailed Answer: 1. His current medications are for control of epilepsy and would not cause dementia. Dr Trishit XXXXXXX is a good neurologist and his opinion can be followed. 2. It is not advisable to start medicines without confirming the diagnosis. So, I would not advise you to start drugs without examination by a doctor. Which place does your father live? All medicines may have side effects, so, we should be careful in starting any medicine. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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Follow-up: What could be the cause for memory loss with a history of cerebral stroke? 18 minutes later
We arranged an appointment with Dr. Trishit XXXXXXX a month back. I took my father to him. He checked his condition. He simply said me "I do not understand the reason of these problems (what I stated you as memory loss, irrelevant talk etc.)...current medications should not create such problems...I am not sure what to do". I am completely speechless after such comment from a doctor. After that, we continue the medications as he prescribed but symptoms go worse. He never mentioned anything about dementia or similar problems or relevant diagnosis. That's why I need your help. My father lives at Haldia, nearly 130 km from Kolkata.
 
 
Answered by Dr. Sudhir Kumar 5 hours later
Brief Answer: Thank you for getting back. Detailed Answer: It is unfortunate that the doctor could not help your father. I also understand the difficulty in taking him frequently to Kolkata via a long road journey. The consultation with neurologist/psychiatrist is not emergency. If it can be arranged in the next few weeks, it should be fine. As I mentioned earlier, I do not want to start the medications without confirming the diagnosis. This is because of possible side effects. A good MD Medicine doctor in Haldia should also be able to prescribe the medicines required by your father until he sees a neurologist. You can mention to the doctor regarding the discussion we had here. Just for information, if we diagnose dementia in a patient, we usually start Tab Donepezil 5 mg once daily in morning, along with Tab. Memantine 5 mg once daily in the morning. Best wishes, Dr Sudhir Kumar MD DM (Neurology)
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