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Suggest treatment for cerebral venous sinus thrombosis

DOCTOR OF THE MONTH - Nov 2013
Nov 2013
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Neurologist
Practicing since : 1994
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Question
1) This is for my friend. He is 40 years old. working for a Software company and otherwise perfectly healthy person. 100% Vegetarian.
2) He is now very critical and here is what happened --

-- Friday -18th July he got headache and vomiting. Hence 9:30 Am in the morning we took him to the general physician.
-- Physician gave him medicines for acidity which he took for Saturday and Sunday
-- however on Sunday night he suddenly lost control of his body and was not even able to operate TV remote and could not even talk. There were also issues with his right hand and right side of mouth.
-- We moved him to the hospital immediately and doctor said that he has a minor paralysis attack
-- He was immediately moved for CT Scan. -- When we got the report he said there has been bleeding in the brain. This happened Sunday night.
-- On Monday he was taken for MRI, during the noon on Monday. MRI report showed that there is a clot in his brain and because of which there has been a burst
-- He said there was 20-30% bleeding on the left side of the brain because of which there was considerable swelling
- Doctor said that there was no need to do surgery and he will give an injection which will dissolve the clot
- The Doctor also said it happens due to B12 deficiencies. Hence they had started the treatment in that direction.
-- Tuesday 10:30 in the morning Dr. said that due to swelling internal pressure has increased and that can damage even the good part and hence the skull need to be removed for that particular area after which that can be treated
-- We did as the doctor said and he was showing some improvement on Wednesday, 23rd July.
-- However on Thursday Doctor again said that swelling has increased considerably after the surgery and even the bleeding went up. The doctor also said that his brain is dead.
-- This is when the Dr. said that he is super critical and there is no hope of recovery. he was immediately put on ventilator
-- Today morning he was on ventilator, Around noon they removed the ventilator to check how much time he can survive without ventilator.
-- This is the time we realized that the hospital does not have the skillset to treat such advance cases and we took the case history and moved him to XXXXXXX Hall clinic in XXXXXXX
-- XXXXXXX Hall clinic is saying that because of his age and pulse rate, there is a 50% chance of his survival. Which has made us hopeful again.


Now what we are trying to do is understand from you or get your opinion on what you think. We are also consulting with another doctor tomorrow morning but just wanted to check if there is any other information that we can either ask or share with XXXXXXX hall clinic that will help them treat him better.

Any help you can provide us will be greatly appreciated. Please note that he is already in the hospital and being treated by doctors but we just wanted to get your opinion.
Posted Wed, 13 Aug 2014 in Headache and Migraines
 
 
Answered by Dr. Sudhir Kumar 6 hours later
Brief Answer:
Treatment seems to be along correct lines.

Detailed Answer:
Hi,

Thank you for posting your query.

I have noted the case details, the treatment summary and MRI reports of Mr XXXXXXX

He has suffered from a clot in the brain veins, which is quite common in young people, a condition called as cerebral venous sinus thrombosis (CVST).

He has already undergone surgery to reduce the swelling, which increases his chances of survival.

He should also be started on heparin injections to dissolve the clotting in the veins and ensure that the clotting does not increase.

In addition to these, he should be on tube feeding, good nursing care, he should be turned on bed every two hours to prevent bed sores, and prevent any chest infection.

With all these care, he has a very good chance of survival.

I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.

Wishing you good health,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in

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