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Query about operations - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Average Posted in: General Health
Answered by

General & Family Physician
Practicing since : 2008
Answered : 3621 Questions
Doctor :   hi
User :   hello
Doctor :   how can i help u
User :   I am actually trying to become more informed as to the necessity of an operation on a man that has just come out of a coma due to cerebral malaria.
Doctor :   ok
User :   The doctors in this third world country are stating that he will be able to regain usage of his legs as they are currently paralyzed , but only if they operate on him.
Doctor :   what u would u like to know about in cerebral malaria
Doctor :   ok
User :   I know about cerebral malaria, how it is caused, the gravity etc.
Doctor :   ok
User :   this patient became ill preceding 4/24/08, entered the first hospital on 4/24/08 with the classic symptoms, he was interned for approximately 1 week. I spoke with him on 4/29/08 and he seemed to have recovered significantly, but later that day approximately 8 hours he entered into a coma - I do not know his number on the Glasgow coma scale
User :   he awoke today at about 10:00 a.m. thus he was in a coma for 3 days
Doctor :   Cerebral malaria is caused by Plasmodium falciparum malaria that induce changes in mental status and coma.
Doctor :   ok
User :   he has usage of his arms, does speak, hear
Doctor :   ok
Doctor :   as he regained the bladder control
User :   but not his legs - thus the doctor there is telling the family that an operation on his legs is necessary to regain usage
Doctor :   ok
User :   he is currently in a catheter - the color of the urine has returned to yellow
Doctor :   ok fine
User :   it had been the wine color as is evident with cerebral malaria but is not back to a normal color
Doctor :   i will tel u how is it caused
User :   not = now
Doctor :   and gravity u had asked about
Doctor :   ok
User :   okay
Doctor :   i appreciate details history u have given
Doctor :   and concern ur showing for the person
User :   well I am very concerned, and yes I am a great historian and even though I am not a doctor , I have extensive knowledge in the field
Doctor :   k
Doctor :   Malaria is an infectious disease caused by a parasite that's transmitted by mosquitoes as u know
User :   I would like to know the reason these doctors are stating he requires surgery - what kind of surgery could it be?
User :   yes
Doctor :   did they specify the type of surgery he needs
Doctor :   or could u type the final diagnosis
Doctor :   that can help me understand the clincial state he is as of now
User :   no, his family members due to their level of ignorance don't comprehend medical terminology etc. I have demanded to speak with the doctor to verify the reason for this surgery
Doctor :   k
User :   I had told the family that I thought physical therapy would have only been needed
Doctor :   since its difficult to comment on the current state of clinical
Doctor :   condition
User :   this doctor alleges that with the surgery he will walk again and without it he won't
Doctor :   patient is in
User :   from your knowledge what types of surgeries are performed on patients that are suffering paraplegia due to cerebral malaria/coma
Doctor :   it will be difficult for me to comment on what kind of surgery doctors have planned for him
Doctor :   k
User :   I am aware of that - could you at least comment on a variety of procedures that may seem typical in a case like this - if surgery was recommended - i am trying to become more informed as what those surgeries may be
Doctor :   sure
Doctor :   i would
User :   do you find it normal in a case like this? or strange?
Doctor :   cerebral malaria may present paraplegia
User :   by the way this patient is 33 years old
Doctor :   ok
User :   with no known priors etc.
Doctor :   ok
User :   so what kind of surgery would they actually porssibly do on a patient like that?
Doctor :   Yes, as I am chatting with some patients simultaneously. Please bear with us for a reply
User :   okay
User :   from my knowledge this man did say he had had malaria 3 or 4 times before in his lifetime as to which of the 4 strains he contracted - I don't know
Doctor :   ok
Doctor :   cerebral malaria is usually caused by plasmodium falciparum
User :   yes I aware of that
Doctor :   k
User :   my concern is determining the reason for the surgery they suggest and how they will go about performing it - could it be performed laparascopically?
User :   or will any surgery be done excisionally?
User :   would they enter the spinal cord, the legs directs or the brain?
Doctor :   since iam not in the position to physically examine the patient , i wouldnt able to comment on that
User :   could you please just comment in general then as to the types of surgeries performed on a post coma patient whose legs are paralyzed that supposedly will regain usage if operated upon? what type of surgery could be done and how?
Doctor :   ok
Doctor :   generally doctors advise paralyzed
Doctor :   surgery depends on the cause of the condition
Doctor :   whether it is due trauma or intra cerebral bleed
Doctor :   or to decrease intra cranial tension
Doctor :   generally doctors advise physiotherapy
Doctor :   for paralyzed
Doctor :   r u there
User :   yes i am quite aware of all that
Doctor :   ok
User :   that is why I am questioning the need for surgery when I would have thought physiotherapy is all that he would require
Doctor :   what u want to know about specifically
Doctor :   ok
User :   as stated repetitively - I am looking for the actual names of surgeries that these doctors may perform on this legs so that he regain usage of them
User :   does it seem strange to you that these doctors are recommending surgery? and if so what would be the typical surgery
Doctor :   the treating the doctors would be the best person to comment
Doctor :   any doubts u have can be put to them
Doctor :   since they have seen the patient and examined
Doctor :   they will be able to answer to ur question
User :   obviously any coma is grave, but he was only in one for 3 days
Doctor :   anything else u want to ask about
User :   the issue is that they are in a third world country thus it is difficult to reach them most of time and speak with the doctor
Doctor :   i didnt get u
Doctor :   could u specify what u want
User :   I have been asking you the specific name of a possible surgery these doctors may be considering or what you think it may be - i know you don't know the case, the history etc. etc. - but just give me some general surgical names so I can then look them ujp on the internet that could possibly fit this case
Doctor :   ok
User :   also do you think it is strange that they are suggesting surgery versus just physiotherapy?
Doctor :   there are surgeries to decompress the chord
User :   how is that peformed?
Doctor :   in trauma causes
User :   what is the actual term for that kind of surgery so I can look it up
Doctor :   Surgery may be considered if the spinal cord is compressed and when the spine requires stabilization
Doctor :   The surgeon decides the procedure that will provide the greatest benefit for the patient.
Doctor :   Different tissue and bony structures including vertebrae misaligned from the force of injury, a herniated disc, or a haematoma can cause spinal cord compression. An unstable spine may require spinal instrumentation and fusion to build in support.
User :   he became paralyzed because of intracranial pressure due to the malaria not an actual accident of trauma to the spinal cord
Doctor :   i know
User :   he doesn't have any of that
Doctor :   ok
Doctor :   so only i told u
Doctor :   i cant comment on the surgery they have planned to do
Doctor :   this is the surgery they do usually for the patients who have trauma generally
Doctor :   anything else u want to know about
User :   i know you can't - just names 5 typical surgeries to eliminate paralysis in the legs after recovering from a coma due to cerebral malaria
User :   i am not looking for a trauma surgery - i am looking for one related to his situation
User :   just name the surgeries
User :   the medical names - i.e. laminectomony, etc. etc.
User :   i will look them up myself
Doctor :   ok fine
Doctor :   v
User :   just sprew out the names
Doctor :   Your case requires undivided attention and as I am chatting with few other patients. I can get back to you with the necessary information by email or I can give you a Chat appointment.
User :   i can wait
User :   time is of the essence
Doctor :   k
Doctor :   I think that for your case we will need to take the opinion of our panel of specialists. We shall present your case history to the concerned specialist and get back to you with an email.
Doctor :   Thanks for consulting Health care magic. Bye for now.
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