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Hi, Here Is A Quick Question. My Dad Had A

Posted on Sun, 20 Sep 2020

Question: hi,
Here is a quick question. My dad had a stroke. Brain veins clogged. unfortunately, he wasn’t treated in the critical time period. 4 days passed, his speech and vision are normal. He can feel his legs and arms. however he cannot walk. He is using clot buster, 60 mg lixiana. Is there anything else at this point we can do? he will get physical therapy. thanks

Answered by Dr. Sudhir Kumar (9 hours later)

Brief Answer:
He is on correct treatment.

Detailed Answer:
Hi,

Thank you for posting your query.

I am Dr Sudhir Kumar, Neurologist, and would try my best to help you.
I have noted your dad's clinical details. He has suffered a stroke, and possibly missed thrombolytic treatment with tissue plasminogen activator (alteplase), which can be given only during the first 4.5 hours of stroke onset.

Lixiana (edoxaban) is not a clot buster, however, it prevents recurrence of stroke in patients with atrial fibrillation (AF). This treatment is needed for long-term.

I assume that he has no other risk factors for stroke such as diabetes, high BP or cholesterol. If present, they also need to be controlled.

Physical therapy is already going on, which would help in recover over time.

I sincerely hope my reply has helped you.

I would be pleased to answer, if you have any follow up queries or if you require any further information.

Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/

Above answer was peer-reviewed by : Dr. Vaishalee Punj

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

Hi Dr. XXXXXXX Thanks for your response. Unfortunately, He has diabetes type 2. We are constantly monitoring his blood sugar. If it exceeds 200, they will give him insulin injection. Let me tell you the whole situation. I think he got some virus(covid negative) and went to hospital. They gave him steroid shot. Clearly it increased his blood sugar, then stroke happened. However, he got dvt surgery a mont ago and he was on lixiana since one month. So stroke happened, while he was on lixiana. As far as I understood, there is nothing else to do at this point other than physical therapy. However, what would you suggest that we would do to prevent another stroke from happening? thanks

Answered by Dr. Sudhir Kumar (36 minutes later)

Brief Answer:
Stroke work up and a few additional medicines would be needed.

Detailed Answer:
Thank you for getting back with more information.

It seems now that he developed stroke due to combined effects of viral infection (which causes inflammation and increases the risk of stroke- both covid and non-covid viruses do that) and diabetes. However, other stroke work up should be done, if not already done. These would include:

1. Blood tests- Lipid profile, serum homocysteine

2. Echocardiogram, ECG

3. MRI with MR Angiogram Brain, Carotid doppler

Medications for stroke prevention are- clopidogrel and atorvastatin. The doctor may not have started clopidogrel, as he is still on lixiana. However, once lixiana is stopped, clopidogrel (or aspirin) should be started. Atorvastatin can be started now also.

Best wishes,

Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Nagamani Ng