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Suggest Treatment For Memory Loss And Drowsiness
Question: Hi,
Please forward this question to Dr. A.S XXXXXXX or Dr. XXXXXXX XXXXXXX (Neurologists) ONLY.
Cause: Loss of memory and awareness, Patient is currently in ICU.
Expectation: Various diagnosis and solution from your end, please help with supporting facts.
History:
My Dad is 62 years old. He is a retired government employee. From past 2 years, he is at home and has been leading sedentary lifestyle. He is diabetic since 26 years and He has blood pressure since 10 years. He is using insulin injections since 15 years. We started seeing kidney anomalies since 5-6 years. The creatinine, urea levels started rising above normal range since 1 year. We started the dialysis since October 13, 2014 because his legs were swollen, was vomiting and he had severe itching almost all over the body. At first, dialysis was 3 times a week and now it is 2 times a week. The AV fistula is done on his left hand. There was no significant decrease in urea level even after the dialysis process. His urea level had always been around 65-80.
After the dialysis was started, for 1.5 months, though he lost 15 kgs, he was fine. He was on high protein diet and occasionally used to vomit. He often mentioned that he does NOT have much strength in his legs, it is difficult for him to get up from chair or walk for long distance. He did not mention about imbalance but only mentioned of lack of strength.
Recent symptoms:(past 15 - 20) days
-> he gets headache occasionally, usually when he wakes up.
-> He has got herpes on his left leg since 7th December and it has spread a little to his left buttock and to the right ankle. It is bit doubtful that it is on his buttock because it is difficult to differentiate between itching marks and blisters.
-> Since 20 days month there were few times, when he wakes from the nap/sleep, he had no idea, where he is and he used to forget where is the kitchen, bathroom. He was able to recall once we explain. This memory loss condition lasted only for few minutes and it was intermittent. He has fallen down couple of times while getting out of the bed or the chair and this may have happened because of imbalance rather than the lack of strength in his legs.
-> On 13th December the memory loss got way to severe he used to forget once every 5 minutes. This time, the condition lasted for more than 8 hours and his sugar levels were high so we took him to the doctor.
-> Sugar levels 400 on 11th December and 554 on 13th December. Blood pressure 160, Urea 110, Creatinine 6.5.
-> There has been no fever recently
-> There has been no frequent vomiting recently.
-> He has never wet the bed and always knew whenever he wants to urinate and went to the bath room.
Initial treatment:
The doctor said the memory loss condition might have happened because of high sugar level (500). We got him admitted and his sugar levels were brought down but there was no improvement on the memory part and it was getting worse. On 14th December, the doctor recommended a different hospital and adviced to consult a neuro surgeon as his condition was deteriorating. On 14th December evening, my dad was admitted to MICU with ventilator as he was not opening his eyes and was not responding to our words. He was reacting to the pain, move his hands but he was not self aware.
The treatment that has been done so far is mentioned in the link mentioned at the end of this page. The reports includes clinical summary, all tests results, X-ray result, MRI CD and report.
Important questions needs to be answered:
1) Doctors are planning to drain the liquid from brain. Will therapeutic lumbar puncture / EVD help my dad to wake up and open his eyes? What is the life risk involved in this procedure ?
2) Please let me know if you know any other procedures.
Thanks in advance!
Note : Patient name and hospital name has been intentionally kept anonymous.
Steps to access the reports:
1) The reports are available at the link https://drive.google.com/file/d/0B9UwHj2KKh0gVEJhQjJrVTFjZWs/view?usp=sharing
2) Before opening the "All in one" folder, please download it first by clicking the "down arrow" button at the top.
3) After downloading, extract using winzip and winrar
4) To access MRI film, please open "MRI CD" folder and open "Autorun.exe"
Please forward this question to Dr. A.S XXXXXXX or Dr. XXXXXXX XXXXXXX (Neurologists) ONLY.
Cause: Loss of memory and awareness, Patient is currently in ICU.
Expectation: Various diagnosis and solution from your end, please help with supporting facts.
History:
My Dad is 62 years old. He is a retired government employee. From past 2 years, he is at home and has been leading sedentary lifestyle. He is diabetic since 26 years and He has blood pressure since 10 years. He is using insulin injections since 15 years. We started seeing kidney anomalies since 5-6 years. The creatinine, urea levels started rising above normal range since 1 year. We started the dialysis since October 13, 2014 because his legs were swollen, was vomiting and he had severe itching almost all over the body. At first, dialysis was 3 times a week and now it is 2 times a week. The AV fistula is done on his left hand. There was no significant decrease in urea level even after the dialysis process. His urea level had always been around 65-80.
After the dialysis was started, for 1.5 months, though he lost 15 kgs, he was fine. He was on high protein diet and occasionally used to vomit. He often mentioned that he does NOT have much strength in his legs, it is difficult for him to get up from chair or walk for long distance. He did not mention about imbalance but only mentioned of lack of strength.
Recent symptoms:(past 15 - 20) days
-> he gets headache occasionally, usually when he wakes up.
-> He has got herpes on his left leg since 7th December and it has spread a little to his left buttock and to the right ankle. It is bit doubtful that it is on his buttock because it is difficult to differentiate between itching marks and blisters.
-> Since 20 days month there were few times, when he wakes from the nap/sleep, he had no idea, where he is and he used to forget where is the kitchen, bathroom. He was able to recall once we explain. This memory loss condition lasted only for few minutes and it was intermittent. He has fallen down couple of times while getting out of the bed or the chair and this may have happened because of imbalance rather than the lack of strength in his legs.
-> On 13th December the memory loss got way to severe he used to forget once every 5 minutes. This time, the condition lasted for more than 8 hours and his sugar levels were high so we took him to the doctor.
-> Sugar levels 400 on 11th December and 554 on 13th December. Blood pressure 160, Urea 110, Creatinine 6.5.
-> There has been no fever recently
-> There has been no frequent vomiting recently.
-> He has never wet the bed and always knew whenever he wants to urinate and went to the bath room.
Initial treatment:
The doctor said the memory loss condition might have happened because of high sugar level (500). We got him admitted and his sugar levels were brought down but there was no improvement on the memory part and it was getting worse. On 14th December, the doctor recommended a different hospital and adviced to consult a neuro surgeon as his condition was deteriorating. On 14th December evening, my dad was admitted to MICU with ventilator as he was not opening his eyes and was not responding to our words. He was reacting to the pain, move his hands but he was not self aware.
The treatment that has been done so far is mentioned in the link mentioned at the end of this page. The reports includes clinical summary, all tests results, X-ray result, MRI CD and report.
Important questions needs to be answered:
1) Doctors are planning to drain the liquid from brain. Will therapeutic lumbar puncture / EVD help my dad to wake up and open his eyes? What is the life risk involved in this procedure ?
2) Please let me know if you know any other procedures.
Thanks in advance!
Note : Patient name and hospital name has been intentionally kept anonymous.
Steps to access the reports:
1) The reports are available at the link https://drive.google.com/file/d/0B9UwHj2KKh0gVEJhQjJrVTFjZWs/view?usp=sharing
2) Before opening the "All in one" folder, please download it first by clicking the "down arrow" button at the top.
3) After downloading, extract using winzip and winrar
4) To access MRI film, please open "MRI CD" folder and open "Autorun.exe"
Brief Answer:
Treatment seems to be along correct lines.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted the details of your dad and I appreciate the detailed accounts provided by you.
The main issue here seems to a cognitive decline, in the form of memory loss and drowsiness, which is of fairly short duration.
This can be explained by the infarcts noted in his brain (infarcts refer to the areas of reduced blood supply, also commonly known as brain stroke). Recovery of neurological functions occur in brain stroke, though it takes weeks to months.
Other cause such as brain infection was suspected, however, the same was ruled out by doing a CSF analysis (lumbar puncture). In any case, he was given antibiotics for the same.
I noted that drainage Lumbar Puncture (LP) has been planned to exclude normal pressure hydrocephalus (NPH). This is a safe procedure, however, I do not expect to see any significant improvement with this procedure.
He has had seizures, which are being treated with phenytoin and levetiracetam. The only thing is that we should rule out "subclinical seizures" by doing continuous EEG monitoring, as subtle seizures can be missed, if we only rely on clinical examination.
Adequate control of metabolic factors, including blood sugars (by insulin) and urea/creatinine (by dialysis) would also help.
Active/passive physiotherapy, good nutrition, cognitive stimulation with music through headphones, nursing in a well-lit room/ICU etc are also very important in ensuring faster recovery.
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:/XXXXXX
Treatment seems to be along correct lines.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted the details of your dad and I appreciate the detailed accounts provided by you.
The main issue here seems to a cognitive decline, in the form of memory loss and drowsiness, which is of fairly short duration.
This can be explained by the infarcts noted in his brain (infarcts refer to the areas of reduced blood supply, also commonly known as brain stroke). Recovery of neurological functions occur in brain stroke, though it takes weeks to months.
Other cause such as brain infection was suspected, however, the same was ruled out by doing a CSF analysis (lumbar puncture). In any case, he was given antibiotics for the same.
I noted that drainage Lumbar Puncture (LP) has been planned to exclude normal pressure hydrocephalus (NPH). This is a safe procedure, however, I do not expect to see any significant improvement with this procedure.
He has had seizures, which are being treated with phenytoin and levetiracetam. The only thing is that we should rule out "subclinical seizures" by doing continuous EEG monitoring, as subtle seizures can be missed, if we only rely on clinical examination.
Adequate control of metabolic factors, including blood sugars (by insulin) and urea/creatinine (by dialysis) would also help.
Active/passive physiotherapy, good nutrition, cognitive stimulation with music through headphones, nursing in a well-lit room/ICU etc are also very important in ensuring faster recovery.
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:/XXXXXX
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hi,
Thanks for the quick response. I have few questions.
1) My dad has been in ICU for 5-6 days now and it is becoming very expensive for us. What can be done to move him out of ICU with affecting his health in a major way ?
2) could you please provide additional information about "cognitive simulation with music". What kind of music should be played ? Is it okay to play the songs which he likes?
3) Could you please provide additional information about active/passive physiotherapy ? Since, he is lying on the bed all the time, what exactly do I need to inform the doctors over about physiotherapy?
4) could you please examine MRI report once and let me know if there is any brainstroke. If you are not able to access the MRI film, then follow the below mentioned steps. I have added additional steps this time.
> Please perform the 4 steps mentioned in earlier response.
> If the step 4 didnt work then, if you are getting errors then proceed with the following.
> Download the dicomviewer software from here
http://www.microdicom.com/component/docman/doc_download/96-microdicom-viewer-088-x86.html
> Install and Open the software.
> Now choose to open folder and select the downloaded location "All in one" folder / "MRI CD"/DICOMDIR file which should open all the images.
Thanks again for the quick reply. Your inputs assured us that we have got the correct treatment so far. That is a big relief. Your inputs are very important for us, please let us know your opinion.
Thanks for the quick response. I have few questions.
1) My dad has been in ICU for 5-6 days now and it is becoming very expensive for us. What can be done to move him out of ICU with affecting his health in a major way ?
2) could you please provide additional information about "cognitive simulation with music". What kind of music should be played ? Is it okay to play the songs which he likes?
3) Could you please provide additional information about active/passive physiotherapy ? Since, he is lying on the bed all the time, what exactly do I need to inform the doctors over about physiotherapy?
4) could you please examine MRI report once and let me know if there is any brainstroke. If you are not able to access the MRI film, then follow the below mentioned steps. I have added additional steps this time.
> Please perform the 4 steps mentioned in earlier response.
> If the step 4 didnt work then, if you are getting errors then proceed with the following.
> Download the dicomviewer software from here
http://www.microdicom.com/component/docman/doc_download/96-microdicom-viewer-088-x86.html
> Install and Open the software.
> Now choose to open folder and select the downloaded location "All in one" folder / "MRI CD"/DICOMDIR file which should open all the images.
Thanks again for the quick reply. Your inputs assured us that we have got the correct treatment so far. That is a big relief. Your inputs are very important for us, please let us know your opinion.
Brief Answer:
Once stable, he can come out of ICU.
Detailed Answer:
Thank you for getting back.
1. I agree that ICU care is expensive, and so in future, please get medical insurance done for all family members, upto 20 lakhs (Max Bupa, Apollo Munich, Andhra Bank, etc insure for that amount).
Right now, once his breathing is adequate without ventilator, he can be shifted out of ICU.
2. Any music of his choice is good.
3. Physiotherapy can be done under the guidance of a good physiotherapist with BPT or MPT degree. In ICU patients, chest percussions are important to treat and prevent lung infections. Passive movements of legs should be done to prevent clotting of blood in leg veins and to prevent contracture.
4. There is evidence of brain stroke on the MRI.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Once stable, he can come out of ICU.
Detailed Answer:
Thank you for getting back.
1. I agree that ICU care is expensive, and so in future, please get medical insurance done for all family members, upto 20 lakhs (Max Bupa, Apollo Munich, Andhra Bank, etc insure for that amount).
Right now, once his breathing is adequate without ventilator, he can be shifted out of ICU.
2. Any music of his choice is good.
3. Physiotherapy can be done under the guidance of a good physiotherapist with BPT or MPT degree. In ICU patients, chest percussions are important to treat and prevent lung infections. Passive movements of legs should be done to prevent clotting of blood in leg veins and to prevent contracture.
4. There is evidence of brain stroke on the MRI.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
PLease direct this follow up questions to Dr XXXXXXX XXXXXXX only.
Hello Doctor,
My dad has got a new infection/disease. Please go through the updated clinical summary. All the reports and summary are found at the link.
CLINICAL_SUMMARY - https://drive.google.com/file/d/0B6t2wBlPTTSQcFhLdE5fM3V2dUU/view?usp=sharing
MRI_CONTRAST - https://drive.google.com/file/d/0B6t2wBlPTTSQTl9HVWhMRjNjUU0/view?usp=sharing
MRI_PLAIN - https://drive.google.com/file/d/0B6t2wBlPTTSQeW9vR01EWVVWRzQ/view?usp=sharing
My questions:
Now he has got severe lung infection and now his immunity is also dropped. What treatment would you suggest? Is there any hope of getting better in this situation.
2) How many days, would it take for him to become stable and healthy enough to be shifted to the wards from ICU
3) How will be his life after he gets discharged from the hospital. will he be bedridden ?
Please let us know your suggestions.
Note : The steps to download the reports are same as the ones that is mentioned in the earlier responses.
Hello Doctor,
My dad has got a new infection/disease. Please go through the updated clinical summary. All the reports and summary are found at the link.
CLINICAL_SUMMARY - https://drive.google.com/file/d/0B6t2wBlPTTSQcFhLdE5fM3V2dUU/view?usp=sharing
MRI_CONTRAST - https://drive.google.com/file/d/0B6t2wBlPTTSQTl9HVWhMRjNjUU0/view?usp=sharing
MRI_PLAIN - https://drive.google.com/file/d/0B6t2wBlPTTSQeW9vR01EWVVWRzQ/view?usp=sharing
My questions:
Now he has got severe lung infection and now his immunity is also dropped. What treatment would you suggest? Is there any hope of getting better in this situation.
2) How many days, would it take for him to become stable and healthy enough to be shifted to the wards from ICU
3) How will be his life after he gets discharged from the hospital. will he be bedridden ?
Please let us know your suggestions.
Note : The steps to download the reports are same as the ones that is mentioned in the earlier responses.
Brief Answer:
His condition has deteriorated.
Detailed Answer:
Thank you for getting back and sending more follow up information.
Overall, his condition has deteriorated, which is mainly on account of severe pneumonia (lung infection), which has spread to blood (sepsis) and resulting in shock (very low BP) and hypoxia (less oxygen).
This needs good efforts from ICU doctor as well as chest physician. Some people recover, however, exact chances of recovery can be predicted by ICU doctor and chest physician.
He is on correct treatment at the moment (high end antibiotics and mechanical ventilator).
At least one week stay in ICU may be needed, however, it may get prolonged depending on the extent of recovery of lung infection.
Once he gets discharged, he would be bedridden initially. However, with physiotherapy, he would recover his functions slowly.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
His condition has deteriorated.
Detailed Answer:
Thank you for getting back and sending more follow up information.
Overall, his condition has deteriorated, which is mainly on account of severe pneumonia (lung infection), which has spread to blood (sepsis) and resulting in shock (very low BP) and hypoxia (less oxygen).
This needs good efforts from ICU doctor as well as chest physician. Some people recover, however, exact chances of recovery can be predicted by ICU doctor and chest physician.
He is on correct treatment at the moment (high end antibiotics and mechanical ventilator).
At least one week stay in ICU may be needed, however, it may get prolonged depending on the extent of recovery of lung infection.
Once he gets discharged, he would be bedridden initially. However, with physiotherapy, he would recover his functions slowly.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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