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CT scan shows intracerebral bleed, cortical vein thrombosis, patchy sliosis. Want explanation

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Posted on Sat, 25 Aug 2012
Question: Hi Dr. XXXXXXX .

My Name is Sangeeta and I wanted to discuss my dad's case with you. He was hospitalized on the 15th July 2012 under the case of Hypertension. Later on a few CT scans were conducted which concluded a clot in the right side of the Brain.
Later on the 16th July a CT cerebral angiography was performed on dual source dual energy 64 slice MDCT for which the findings were: intracerebral bleed noted in right paramedian frontal lobe & posterior cingulate gyrus measuring 44x28x14mm (Anterposterior, craniocaudal and mediolateral dimensions) with mild perilesional edema. blood level noted in posterior aspect of the bleed.
Small linear hyperdensity noted extending from bleed joining inferior saggital sinus---? Cortical vein thrombosis.
Patchy sliosis noted in left lentiform nucleus-- Sequelae of previous vascular insult.
White matter hypodensities noted in left parietal lobe-- Ischemic.
Asymmetry of lateral ventricles with prominence on left side.
Posterior fossa structures including fourth ventricle are normal.
Rest of ventricular system is normal.
Rest of cerebral parenchyma shows normal grey/white matter differentiation.
Cortical sulci, sylvian fissure & basal cisterns are normal.
No midline shift.***** continued in medical history****
doctor
Answered by Dr. Sudhir Kumar (41 minutes later)
Hi XXXXXXX

Thank you for your post and asking for my opinion on your dad's case. I have gone through details sent by you, and the CT brain, cerebral angiography and MR venography reports.

The most likely diagnosis is cortical vein thrombosis. In this condition, blood clots in the brain veins, leading to bleeding as well as ischemia (lack of blood flow) in the brain.

Common symptoms can be seizures (fits), headache and weakness of hands and legs.

This condition is often treated by medications, including anticoagulants (blood-thinners) and anti-epileptic drugs.

Some blood tests (thrombophilia profile, homocysteine) are required to find out the underlying reason for getting clotting in the brain veins.

Most people respond to medical treatment and improve within 3-6 months. Physiotherapy is also useful in recovery.

Please get back if you have any more queries. I would be pleased to help you and your dad in ensuring a good recovery.

Best wishes,

DR XXXXXXX XXXXXXX MD DM XXXXXXX consultant Neurologist
Apollo Health City, Hyderabad.
Above answer was peer-reviewed by : Dr. Aparna Kohli
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Follow up: Dr. Sudhir Kumar (46 hours later)
Hi Dr XXXXXXX

Thank you for looking into our case.

The following are the BLOOD reports I could dig into from the medical file.

One test has been conducted for homocyateine dated 23/07/2012

The inferences are as follows:

Plasma for homocysteine 15.5
CBP
haemoglobin 8.8
PCV 28.50
Total RBC 3.80
Total WBC 11,800
Platelet 2.60
DIFFERENTIAL COUNT
Polymorphs 78.0
Lymphocytes 18.0
Eosinophils 2.0
Monocytes 2.0
Basophils 0.0

PERIPHERAL SMEAR
RBC NORMOCYTIC,FEW MICROCYTES,MILD HYPOCHROMIC,MILD
ANISOPOIKILOCYTOSIS
WBC NEUTROPHILIC LEUCOCYTOSIS
PLATELETS ADEQUATE ON SMEAR

3 tests have been done for PT with INR and APTT,the latest test done was on 24/07/2012 and the inferences are

PT with INR
TEST 17.90
CONTROL 12.70
INR 1.41
NOTE oral anticoagulant THERAPEUTIC RANGE:INR=2.0-3.0
METHOD scattered light detection method
POTASSIUM 4.60
METHOD ion selective electrode
APTT:
TEST 34.00
CONTROL 34.00
METHOD scattered light detection method
BLEEDING TIME 3min00sec
METHOD Duke's method
CLOTTING TIME 5min00sec
METHOD Capillary method

Current Medication, Food and Physical condition of the patient:

* We are getting an Ayurvedic Full Body massage done by physiotherapist. (His left side is mildy paralyzed. He is currently able to walk with a little support and Baby walks without support)
* Following a diet which consists of low salt & oil, no bakery items, no meat, no fried items, giving fruits and juices twice a day
* Patient has developed a sore throat when he had a guava and grape juice. (please advice if this is common)
* Request you to please help us on the medication for the clot.


Regards,
XXXXXXX
doctor
Answered by Dr. Sudhir Kumar (16 minutes later)
Hi XXXXXXX

Thank you for getting back with more details.

I have gone through the tests. The following are my comments:

1. Regarding blood tests - his hemoglobin is low. This needs certain medications such as iron supplements.

2. Homocysteine level is mildly elevated. This can be reduced with certain vitamin supplements such as folic acid.

Both low hemoglobin (anemia) and elevated homocysteine can be risk factors for clotting of blood in brain veins. Your doctor would advise regarding the above medications.

3. PT/INR test is done to adjust the dose of anticoagulant (blood thinner medication). Is he on any anticoagulant drugs? Your doctor will do the dose adjustment after seeing this blood report.

4. Diet and physiotherapy (including massage) seem to be fine (what your dad is following).

4. Sore throat is not common; but there is no need to worry. It wouldn't affect his progress.

Hope I have addressed your concern. Let me know if I have missed any concern.

Best wishes,

Dr Sudhir Kumar MD DM
Consultant Neurologist
Apollo Health City, Hyderabad

Above answer was peer-reviewed by : Dr. Prasad
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CT scan shows intracerebral bleed, cortical vein thrombosis, patchy sliosis. Want explanation

Hi XXXXXXX

Thank you for your post and asking for my opinion on your dad's case. I have gone through details sent by you, and the CT brain, cerebral angiography and MR venography reports.

The most likely diagnosis is cortical vein thrombosis. In this condition, blood clots in the brain veins, leading to bleeding as well as ischemia (lack of blood flow) in the brain.

Common symptoms can be seizures (fits), headache and weakness of hands and legs.

This condition is often treated by medications, including anticoagulants (blood-thinners) and anti-epileptic drugs.

Some blood tests (thrombophilia profile, homocysteine) are required to find out the underlying reason for getting clotting in the brain veins.

Most people respond to medical treatment and improve within 3-6 months. Physiotherapy is also useful in recovery.

Please get back if you have any more queries. I would be pleased to help you and your dad in ensuring a good recovery.

Best wishes,

DR XXXXXXX XXXXXXX MD DM XXXXXXX consultant Neurologist
Apollo Health City, Hyderabad.