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How to prevent recurrence of a stroke?

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Internal Medicine Specialist
Practicing since : 1980
Answered : 1357 Questions
please advise us if my husband is a candidate for stent /by pass we were told in hospital no surgery carotid artery is severed narrowed, but we went further to ask radiology who want to do an angiogram from groin to neck to see artery in brain but from all the recent mri/mra angiogram can they at this time give their opinion if he is a candidate for stent because ok he did this angiogram from groin which they said it about 2% risk of getting a stroke from this test but after test they will discuss surgery risk what if risk is more then ....where he is right now ,, they said he can get another stroke which may paralyze him within about 3-6 months maybe less his pronosis is very high for another stroke soon so we have to do prevent care he is on 80 mg statin, 20mgplavix, 1000 keppra, here is I the dec 2013 mra stoke 434.91 headache blurr vision the right supraclinoid internal carotid is severed narrowed worse compared to the prior study the right A1 segment is diffusely narrowed also worse. The left distal MCA is narrowed and irregular similar to the prior study. Severe narrowing of the supraclinoid right internal cerebral artery and additional bilaterly irregularity and narrowing of anterior and middle cerebral artery branches, findings are likely related to atherosclerotic disease, however given improvement of stenosis in the distal left M1 branch, vasculitis is ot excluded,ALSO I UNDERSTRAND THAT FROM THIS groin angiogram then after a set up a med program to work more with my husband case, when I ask radiology about this if can done now without this new angiogram through groin he said I have to talk to a stroke specialist where he himself said has to do this test then will set up a med program or stent, now I said wait until we see the stroke specialist who give us an appt, in March then there we will ask if my husband is a candidate for stent , bypass or what is program set up to assist him.The next concern is that this word keep coming up with all his MRI since after removal of CNS LYMPHOMA OF THE BRAIN ,encephaolmalacia since 1993 and in 1997 a 1.0 cm whitematter with small ischemic lesion , underlying diseases of the brain saying now 2012,2413 now he has tia 2012, stroke 2012 and stoke 2013, spect mri done lymphoma and ischemic mirrored each other so study as per doctor ruled out the lymphoma its ischemic strokes, could it be this lesion because its still there causing more white matter because I saw images it look white ,doctors stroke how about both of them please address this lesion,white matter and underlying diseases ,as per one report watershed ischemia with encephalamalacia and associated signal abnormality, CAN THIS ENCEPHALAMALACIA CAUSING THESE STOKES AND IF COMING FROM THE UNDERLYING DIEASES OF THE BRAIN WHAT CAN WE DO TO PREVENT FURTHER STROKE OR SLOW DOW THIS DISEASES,COULD IT BE GETTING WORST NOW FRON SINCE 1995,MY HUSBAND HAD RADIATIONS AFTER SURGERY,Also he has hasimoto thyroid, OUR MAIN CONCERN IS TRYING TO PREVENT ANY OTHER STROKE, IF WHITE MATTER GETTING WORST HOW TO SLOW DOWN TO PREVENT ENCEPHALOMALACIA, IF WE ARE NOT ON THE RIGHT TRACK, PLEASE ADVISE ,WE WILL APPRECIATE, EVERY HELP MEANT A BIG HELP FOR US AND ITS BLESSINGS TO SHARE AND HELP,THANK YOU,
Posted Sat, 15 Mar 2014 in Brain and Spine
Answered by Dr. Rakesh Karanwal 5 hours later
Brief Answer: STENT/Bypass is required at the earliest. Detailed Answer: Hi Lady, Thanks for your query. 1. The genesis of all problems is the underlying atherosclerotic disease, and partly due to surgical removal of CNS lymphoma. Under-correction of Hashimoto's Thyroid further accelerates atherosclerosis. 2. I fully agree with the surgeons that chances of a recurrence of stroke are very high. 3. Further, Encephalomalacia is primarily due to ongoing ischemia as a result of narrowing of cerebral arteries; and, partly due to the earlier radiation therapy. Hence, the recommended PLAN OF ACTION to prevent (or reduce the chances of) recurrence of stroke and, slow down further progression of Encephalomalacia is as follows :- * STENT/bypass AT THE EARLIEST, so as to significantly reduce the risk of another stroke. * Aggressive therapy with lipid-lowering drugs, such as statins (he is already on Plavix and Statins), to continue. * Prompt correction of under-acting thyroid state, if any. Consult your doctor and apprise him of my opinion. I am certain that he will agree with me; order required tests, and- based on the reports- will prescribe suitable treatment as advised. Hope I have addressed to your concerns to your complete satisfaction and you find my response helpful and informative. I will be happy to answer further queries, if any. Fond regards and have a nice day, Col (Dr.) Rakesh Karanwal
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