Brief Answer:
Follow the Advises..

Detailed Answer:
Hello xxxxxxx, Welcome to HCM,

I've gone through your query and understand your concern for your Sister,

First of all, I'm really sorry for all the inconvenience caused to you along with this delay, I'll try to solve it with as much as possible..

As you've rightly pointed out, with such a treatment course of Atriptla, not only the viral load is expected to reduce but also a generalized improvement in her overall physical status is expected..

No this headache is much severe than any usual drug induced side effects, and good that you've gone for the essential CT scan of the head..

I've gone through the CT-scan report dear, and you really shouldn't worry about the radiation exposure, as the benefit outweighs the risk here..

The CT scan showed hemorrhage(bleeding) in side Brain, which is 'non-traumatic'- means it's not due to any injury, 'unspecified' means the exact cause has yet to be specified for this..

All those difficulty in looking upwards, feeling excessively sleepy, abrupt sweating are classical symptoms in this conditions..

Now, the initial central nervous system examination was suspicious for ICSOL(Intra Cranial Space Occupying lesion), which, after discussing with Rediologist, has been confirmed as blood in side the brain and ventricles(cisterns in side the brain)..

There are several things missing in this CT, i.e. the exact location, size of the bleed, surrounding edema and pressure effects over other structures, they have to be diagnosed with further clinical examination and investigations..

Dear, she needs urgent medical attention and in patient admission in hospital under a Neurologist/Neurosurgeon who'll keep her monitoring, examine further, start her on anti-edema measures, as well as prophylactic anti-epileptics and further assess for any need for surgical intervention to reduce the pressure symptoms of the brain..

No she's not at all fit for any work now, as you can very well understand due to this severity of symptoms.. I couldn't see any date mentioned there in the scan, and if it's done more than 24 hrs back, then a repeat CT scan is required to see the current situation in side her brain..

Please don't delay any more and take her to your nearest ER/Urgent care along with the CT-reports and other details, from where she'll be promptly admitted and relevant investigations as well as management therapy will be initiated..

Let me know how she stays in the due course..

Let me know if your having any further queries, I'll be glad to clarify further..

Take Care of your Sister dear,
My Best Wishes
Kind Regards

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Brief Answer:
treatment course is prolonged, and extensive investigations required..

Detailed Answer:
Hello xxxxxxxxxxx, Welcome back,

Thanks for following up with these vital details,

Good to know that there's no blood as per your quoted description, but still confirmation can only be obtained after a proper thorough CT/MRI..

Once again, I'm reassuring not to worry about the "powerful ray", simply because the benefit of the investigation outweighs the risk here..

Yes, if it's a space occupying lesion other than than blood (I'd still not comment based on a non-contrast CT, if it's granulomatous or not, simply because it's not conclusive enough to comment on this yet)..

Yes, definitely a Contrast enhanced CT is required which will give a much clear idea to identify the nature of the lesion and any other associated pathology involved..share the complete reports with me once it's done so that I can give you more specific advice in that aspect..

If it's granulomatous then first of all tubercular origin must be ruled out as well as any related abscess and/ fungal infections and/ any other CNS tumor..

Treatment options mainly dependent on the findings..

Other than that, Primary care along with supportive measures like prophylactic anti-epileptics measures(specially since Thalamic region is involved), cerebral decongestants(if any raised intra cerabral pressure is suspected), analgesics, antibiotics etc. have to be continued..

Further investigations may be warranted including a lumbar puncture to analyse the Cerebro Spinal Fluid for any infection(tubercular or any other bacterial, fungal etc.)..

Each of these different etiologies have separate lines of specific treatment so, let them investigate firstly to diagnose the exact cause, then it'll be managed accordingly..

Reversibility depends on the findings dear, so let the exact cause to be found at first..

There's a huge list of drug-drug interaction for Atripla(at least 50 of them), which is unnecessary to know, as it'll only create more confusion.. I strongly believe her doctor is totally aware of them and treating her with the least interactive medication only, please have faith on her doctor, i do believe she's in good hands..

Let me know once further investigations are done, and their reports, i'll be glad to clarify further..

Let me know how she stays in the due course..

Take Care
Kind Regards

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Brief Answer:
You're always welcome to have my suggestions..

Detailed Answer:
Your Most welcome Dear

Yes I'll look forward to hear from you on the further proceedings ..

Best Wishes
Kind Regards

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Brief Answer:
appropriate treatment started, let me know how she's doing in your observation

Detailed Answer:
Hello Dear, Welcome Back,

Thanks for sharing the Repeat Contrast CT and the prescription, it seems there's some inflammation in side the brain and all those changes in the cisterns and mid-brain are secondary to that only..now the exact nature of the swelling (the intra cranial SOL) is not commented here, so may be needed further investigations like a lumber puncture for a complete CSF analysis to rule out infective causes (routine microscopy, gm stain, AFB, culture sensitivity),..

Right now she's been put on a tapering dose of steroids to reduce the swelling, which is appropriate, please ask the neurologist if they are planning to do CSF analysis after steroid therapy..

However, it's their decision when to do it, depending on her clinical improvement..

So far the treatment line is fine, let me know how she's doing in your observation..also discuss with the concerned Neurologist regarding the next step of management (if they're planning to do any further imaging subsequently)..

Let me know how she stays in the due course..any queries your having, feel free to ask, i'll be glad to clarify..

Take Care
Kind Regards

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Brief Answer:
follow-up consultation..

Detailed Answer:
Welcome back Dear,

Stay assured that they're doing the right things for her..

Normally no one discloses the types of management and further planning with the kin, but if you ask then they'll definitely tell you a brief overview of it..

Any way let the steroid therapy continue and observe how she's doing in general as well as neurologically, in case of any doubts feel free to ask me anytime, i'll be glad to clarify..

Take Care
Kind Regards

For future reference you can always get in touch with me, below is my direct follow-up link through which you can contact me anytime anywhere, I'll be happy to help -

http://www.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=71041

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Brief Answer:
It depends from person to person..

Detailed Answer:
Welcome back Dear,

Dear, please try to understand that no one can predict the future, but still since she's in proper hands, receiving appropriate treatment, this should get controlled with the further course of the steroids..

Probable way is mostly conservative only(with the help of medication), unless there's any sudden onset neurological deterioration or no gross improvement in the overall status (which i believe, is not in this present scenario)..

Since I don't have the privilege to examine her clinically, I'll be needing a case summary which describes the total course of stay, investigations and management done during that phase in details, then I'll be able to describe the further details in the line of management..

I believe she's still admitted only, so you can simply ask for the Case summary to them, they'll provide you, with the help of that, even you can correlate a lot of events and off course it's extremely helpful for me to have a detailed systemic documented course in the hospital to determine at least some of the actions in the near future..

I sincerely hope you'll understand what I'm trying to explain here..

In case of any doubts feel free to ask me anytime, i'll be glad to clarify..

Take Care
Kind Regards

For future reference you can always get in touch with me, below is my direct follow-up link through which you can contact me anytime anywhere, I'll be happy to help -

http://www.healthcaremagic.com/Funnel?page=askDoctorDirectly&docId=71041

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Brief Answer:
You're always welcome to have my suggestions..

Detailed Answer:
Welcome Back Dear,

I've already given you as much as details possible to be provided in this short span of window so that you don't stay in the dark, but I need further information too to clarify further, please try to understand ..

I still think, you can simply ask for the Case summary to them, they'll provide you, with the help of that, even you can correlate a lot of events and off course it's extremely helpful for me also to have a detailed systemic documented course in the hospital to determine at least some of the actions in the near future..

I'm always here for help, in case of any doubts feel free to ask me anytime, i'll be glad to clarify..

Take Care
Kind Regards

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